Prevention and Intervention

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?

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:

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.

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.

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/
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.

Source: https://www.live5news.com/2024/09/01/north-charleston-hosts-first-overdose-awareness-day-event/

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
(Spectrum News/Vania Patino)

By Los Angeles

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-

Methods: We recruited 58 MA-dependent young adult females from a compulsory isolation drug rehabilitation center in Sichuan Province and randomly divided them into an MBRP group (n = 29) and a control group (n = 29) according to their degree of psychological craving. The MBRP group received 2 hours of MBRP training twice a week for 4 weeks, alongside routine treatment at the drug rehabilitation center. Meanwhile, the control group solely received routine treatment at the drug rehabilitation center without any additional interventions. The assessment was conducted before and immediately after the intervention, with the Compulsive Drug Use Scale (OCDUS) used to assess craving and the Five-Factor Mindfulness Scale (FFMQ) used to assess trait mindfulness. Also, a “mental feedback monitoring balance” instrument was used to assess concentration and relaxation during some training sessions. This randomized trial was conducted to evaluate the effectiveness of decreasing psychological craving and increasing trait mindfulness.

Results: At baseline, there were no significant differences in total or dimension scores for FFMQ or OCDUS between the two groups (all P > 0.05). After the intervention, the repeated measures ANOVA showed a significant time main effect on changes in observing, non-judging, and non-reacting scores (all P < 0.05), and a significant interaction effect between time and group on both FFMQ total score and OCDUS score (P < 0.01 or P < 0.05). Mental feedback monitoring indicated significant improvement in concentration and relaxation after breath meditation exercises (P < 0.05 or P < 0.001). Additionally, the MBRP group showed improved relaxation during the body scan exercise (P < 0.01).

Conclusion: MBRP training can improve the trait mindfulness of MA addicts and reduce psychological cravings effectively.

The full article can be accessed via the source link below:

Source: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1339517/full

Published Lisbon  16.09.2024

The Croatian national focal point and the European Union Drugs Agency (EUDA) are organising today the latest Reitox Academy on evidence-based prevention. The academy will cover the principles of science-based prevention, feature examples of quality prevention programmes across Europe and discuss models for improving national prevention interventions.

Experts from different countries will present examples of good practice in prevention interventions in diverse settings, including: school (Estonia, Spain, Brazil); family (Estonia) and community (Croatia, Germany) (1).

The event will round off with a session on lessons learned in applying evidence-based prevention programmes and implementing quality standards in the EU. An expert from Bosnia and Herzegovina will share experience from a non-EU country in a final panel discussion.

September 16, 2024

Prevention typically consists of methods or activities that seek to reduce or deter specific or predictable problems. It protects individual well-being and promotes desired behaviors.

Education is a key element of prevention. To understand how to contribute to the prevention of substance use disorders, all individuals need to know two important facts:

Substance use disorders are diseases. They are progressive, chronic, and fatal. They are classified as primary diseases, meaning they are caused by something else, such as an emotional problem or poor choices. Substance use disorders are medical conditions of the brain.

Substance use disorders are treatable. Just as heart disease or diabetes can be treated, so can substance use disorders. In addition to medication, effective treatments usually involve therapy and connecting to community support.

Sharing these facts helps remove stigma around substance use and makes people more comfortable talking about it. This opens up opportunities to:

  • Increase collaboration among state agencies, community organizations, and special populations
  • Develop culturally appropriate strategies and implement plans to reduce risks and increase protective factors across the state and in specific communities
  • Expand citizen participation in community activity

The most promising way to reduce alcohol and drug problems is to use a comprehensive, multi-faceted approach to prevention. There are evidence-based tools that organizations and communities can use to guide these efforts. For example, organizations that adopt a Strategic Prevention Framework and develop logic models are more likely to achieve positive outcomes.

Experts Dedicated to Building Healthy Communities

The RAAD campaign is coordinated by DAABHS (rhymes with “abs”). That’s our abbreviated way of saying the Arkansas Department of Human Services Division of Aging, Adult and Behavioral Health Services the Substance Abuse Prevention team.

The DAABHS team is passionate about uniting individuals and communities in prevention efforts. Each member of the team contributes unique skills and energy to advance the RAAD mission.

They are receptive to questions and ideas and can connect you to existing programs or provide guidance to help you launch new prevention initiatives in your area.

Source: https://humanservices.arkansas.gov/divisions-shared-services/shared-services/office-of-substance-abuse-and-mental-health/prevention-ar/

UC expert joins WVXU’s Cincinnati Edition roundtable discussion

Featured photo at top of an officer speaking with children at school. Photo/SDI Productions/iStock.

The Kentucky Opioid Abatement Advisory Commission recently announced a new three-year drug prevention initiative, funded by grants from the state’s opioid settlement fund for prevention, enforcement, treatment and recovery efforts.

The University of Cincinnati’s LaTrice Montgomery joined WVXU’s Cincinnati Edition to discuss youth drug prevention programs and what research says about the most effective approaches.

The popular DARE (Drug Abuse Resistance Education) program that began in the 1980s originally featured a uniformed officer speaking to kids in a lecture style on how to “just say no” to drugs.

“As we now know, that lecture style doesn’t always resonate with youth,” said Montgomery, PhD, adjunct associate professor in the Department of Psychiatry and Behavioral Neuroscience in UC’s College of Medicine and a licensed clinical psychologist. “So we’ve learned it needs to be much more interactive and include not only drug resistance skills but social and emotional skills.”

As research has progressed, Montgomery said DARE is still around but features a different approach that includes the REAL (Refuse, Explain, Avoid and Leave) method.

Chris Evans, executive director of the Kentucky Opioid Abatement Advisory Commission, told WVXU their team is using a research-based approach to tailor their programs to what will be most effective.

“It’s really designed to encourage young people to make positive life choices and help build up their resilience,” he said. “What this program does is really shine a light again on those strengths of kids and finding a way for them to identify and strengthen what’s going on with them. And we’ve seen the studies have indicated that is a better approach to dealing with kids nowadays in terms of getting them to be educated and to listen and to make positive choices in this space.”

Source: https://www.uc.edu/news/articles/2024/09/are-teen-just-say-no-campaigns-effective.html

Rocky Herron, a former DEA agent, interacting with students after
his drug prevention presentation. (Photo: Business Wire)

CARLSBAD, Calif., October 01, 2024–(BUSINESS WIRE)–In response to the growing crisis of synthetic drugs like fentanyl and methamphetamine, Hopeful Life is proud to announce a vital new initiative in the fight against youth substance abuse. As our nation continues to grapple with the devastating rise of synthetic drugs, there remains a critical gap in educating our youth about the dangers of substance abuse before they make life-altering, or even life-ending, decisions.

Young lives are at risk, and many of them are not fully aware of the dangers. Tragically, drug prevention education is still not a national priority, and our hardest-hit communities often lack the resources to address this crisis head-on. Without proper education, substance abuse continues to destroy futures. This must change. We have partnered with Rocky Herron, a former DEA agent with 31 years of experience, to bring his life-saving drug prevention education directly to schools and communities across the country.

This partnership marks a new chapter for Hopeful Life, as we formally introduce Rocky’s powerful presentations, I Choose My Future, into our comprehensive approach to combating substance abuse. Rocky has successfully engaged over 250,000 youth in 17 countries, transforming the way students think about drugs and their long-term impact. His emotionally charged presentations go beyond raising awareness—they inspire change. Rocky’s presentations connect with students on a personal level, showing them the real-world consequences of drug abuse. His message empowers them to make choices that protect their health and future. As one student shared, “students often comment that they have been told many times that drugs are ‘bad’ but I Choose My Future made them understand why.”

Rocky’s presentations don’t just raise awareness—they change lives. In a recent survey of students in Montana, 64.6% of respondents reported knowing someone personally affected by drug use. After attending Rocky’s presentation, 79.8% of students expressed deeper concern about drug use in their communities, and a remarkable 90.1% felt more comfortable seeking help for themselves or others, a profound shift in understanding and behavior (Rocky Herron Survey Results).

Rocky’s message cuts through the statistics and connects with students on a personal level. They don’t just hear about drug dangers, they see the real-world consequences and are empowered to make choices that shape their futures. As one student shared, “This presentation gave me even more reason to stay away from drugs”​ (Survey).

For adults, Rocky’s presentations provide valuable insights into the connection between substance abuse and mental health, equipping parents and educators with the tools they need to support their children. His sessions cover urgent topics such as fentanyl, synthetic drugs, and vaping, offering practical prevention and intervention strategies.

Hopeful Life believes in creating sustainable, community-wide impact. Our mission is to enhance individual, organizational, and community health through cutting-edge insights and solutions powered by the latest advances in science, technology, and policymaking. We provide comprehensive analytics that measure substance abuse trends and identify correlations at both local and national levels, ensuring our efforts are data-driven and effective. By partnering with Rocky Herron, we amplify his life-changing message where it is needed most, providing critical support to expand his outreach to more schools, more communities, and more at-risk youth.

We don’t just support Rocky’s efforts—we make sure they reach the students who need them most. Through our multidisciplinary approach, we help communities access the life-saving knowledge they need to prevent substance abuse and create lasting change.

The stakes are high. Our youth deserve a chance at a drug-free future, and with your support, Hopeful Life can continue bringing essential education to schools and communities. Every donation helps us reach more students and potentially save lives.

Through our partnership with Rocky Herron, Hopeful Life is expanding its reach to provide more students with the knowledge and tools they need to make informed decisions. Our mission is to enhance community health through education, science, and data-driven solutions. By introducing Rocky’s program, we’re bringing a proven, life-saving message to the forefront of our fight against substance abuse.

Together, we can combat the drug abuse crisis and empower the next generation to make better choices. Please consider donating to Hopeful Life today to support our life-changing mission.

Source: https://finance.yahoo.com/news/hopeful-life-introduces-life-changing-012400527.html?

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 bondingparent-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

Overview

In recent years, police forces in England and Wales have worked more closely with health, education and other local partners to address social issues, such as drug use, youth violence and people in mental health crisis.[1] This aims to ensure that vulnerable people are supported by the most appropriate professional, and that certain complex social issues are not automatically met with a criminal justice response.

These initiatives are sometimes referred to as public health approaches to policing.[2] They can include interventions aimed at preventing offending altogether (for example, early years school-based programmes), as well as ones covering offenders or people coming into contact with the police.[3]

In 2018, organisations representing public health bodies, health services, voluntary organisations and police forces signed an agreement to work more closely together to prevent crime and protect the most vulnerable people in England.[4] Public Health Scotland and Police Scotland announced a formal collaboration in 2021.[5] In 2019, Public Health England and the College of Policing published a discussion paper on public health approaches to policing,[6] and the Association of Police and Crime Commissioners issued guidance in 2023 to support implementation of such approaches.3

Research has found that cooperation between police and health services can help to improve social outcomes. For example:

  • a 2017 study in the USA suggested that health services and police forces have worked effectively together to improve police responses to mental health-related encounters[7]
  • research in 2017 highlighted international examples of how formal collaboration between criminal justice and public health agencies helped to reduce youth violence[8]
  • a 2022 study found that nurses and police officers could develop collaborative teamwork practices in police custody suites in England[9] [10]

There are examples of police forces working with health partners and other agencies to improve responses to vulnerable people in England and Wales:

  • Under drug diversion schemes, police refer people caught in possession of small quantities to voluntary sector treatment services, rather than prosecute for a possession offence. As of 2024, diversion schemes were operating in Thames Valley,[11] West Midlands,[12] and Durham police force areas.[13] The College of Policing and the University of Kent have received funding to evaluate these schemes, which is expected to be completed in 2025.[14]
  • The Right Care, Right Person model aims to reduce the deployment of police to incidents related to mental health and concern for welfare, and instead ensure that people receive support from the most appropriate health or social care professional. Humberside Police developed the model, which includes training for police staff and partnership agreements between police, health and social services.[15] From 2023, police forces nationally were beginning to adopt it, with support from the National Police Chiefs’ Council and the College of Policing.[16]
  • Violence Reduction Units (VRUs) bring together police, local government, health and education professionals, community groups and other stakeholders to provide a joint response to serious violence, including knife crime. The London Mayor’s Office for Policing and Crime established the first VRU in England and Wales in 2019. It states that it takes a public health approach to violence prevention,[17] including deploying youth workers in hospitals and police custody suites.[18] Between 2019 and 2022, the government funded 20 VRUs across England and Wales.[19] In 2019, the government provided funding for the Youth Endowment Fund, which funds and evaluates programmes in England and Wales that aim to prevent children and young people from becoming involved in violence.[20]

Since 2020, Scotland has seen increasing use of diversion from prosecution schemes.[21] In October 2024, the UK’s first official consumption facility for illegal drugs, including heroin and cocaine, was opened in Glasgow.[22]

Challenges and opportunities

In 2023, HM Inspectorate of Constabulary and Fire & Rescue Services noted how police forces were often the “service of last resort” doing the work of other public services, especially with regards to mental ill health.[23] For some vulnerable people, police custody may provide their only space for healthcare interventions.10 Both police forces and voluntary organisations suggest that, at a time when police capacity is under pressure, public health approaches can reduce the amount of time police officers spend dealing with people with complex health needs, who may be referred to other health, care or support services.[24],[25] However, this can also lead to demand and capacity pressures being displaced onto these services.

For example, drug diversion schemes may increase the demand on local drug treatment services, which themselves are facing significant pressures. In her independent review of drugs for the government in 2021, Dame Carol Black raised significant concerns about the capacity and resourcing of drug treatment services in England, and the impact of funding reductions.[26] The Criminal Justice Alliance has called for increased funding for local drug services, to accommodate people being diverted away from the criminal justice system.[27]

The government’s 10-year drug strategy (2021) committed to invest £533 million into local authority commissioned substance misuse treatment services in England from 2022/23 to 2024/25, as part of its aim to “rebuild local authority commissioned substance misuse treatment services in England”.[28] In 2023, the Home Affairs Committee called for all police forces in England and Wales to adopt drug diversion schemes.[29] It also expressed concern about the long-term sustainability and security of funding for the drug treatment and recovery sector.26

Similar pressures in mental health services have led to concerns about the safety of the national rollout of Right Care, Right Person. In November 2023, the Health and Social Care Committee identified urgent questions around the available funding for health services, and the lack of evaluation, in the rollout of the scheme[30] The Royal College of Psychiatrists and the Royal College of Nurses agreed that people with mental illness should be seen as quickly as possible by a mental health professional.[31],[32] However, they and other health, local government, and mental health charities, have expressed several concerns about the programme. These include: the speed and consistency of implementation, lack of funding, the potential for gaps in provision, and increased welfare risks.[33],[34],[35],[36]

Key uncertainties/unknowns

Outside the UK, some public health approaches have involved a significant shift away from enforcing drug possession for personal use through the criminal justice system.[37] For example:

  • Portugal decriminalised possession of drugs for personal use in 2001 and instead refers drug users to support and treatment.[38] Analysis of these measures from researchers and policy experts suggests decriminalisation led to reductions in problematic use, drug-related harms and criminal justice overcrowding.38,[39]
  • In the USA, Oregon trialled a policy in 2020 making drug possession a fineable offence.[40]
  • In Canada, British Columbia trialled an approach in 2023 that decriminalised possession of small amounts of certain drugs for personal use in specific non-public locations.[41]

Citing international examples, some drug policy experts have called on the government to go further in its adoption of a public health approach to drug use.37 The Home Affairs Committee stated in 2023 that the government’s drug strategy should have adopted a broader public health approach, and called for responsibility for misuse of drugs to be jointly owned by the Home Office and Department of Health and Social Care.26 In 2019, the Health and Social Care Committee recommended the government shift responsibility for drugs policy from the Home Office to the Department of Health and Social Care, and for the government to “look closely” at the Portugal model for decriminalisation of drug possession for personal use.[42]

However, Portugal’s approach has also faced criticism. For example, a research review in 2021 highlighted continued social and political resistance to some of the measures 20 years after being introduced.[43] A 2023 editorial in the Lancet highlighted how a recent rise in the use of illicit drugs in Portugal had led to renewed criticism of the policy.[44] More recently, some states in North America have reversed decriminalisation policies, reportedly due to adverse consequences of drug decriminalisation.33,[45][46]

This points to a mixed evidence base internationally for a fully public health approach to drug use. However, it may be difficult to compare international examples, given the different models of decriminalisation that have been adopted, and in a variety of social, economic, political and legal systems.[47]

Key questions for Parliament

  • Should the government do more to support the implementation of public health approaches to policing across England and Wales, considering both the police, and health, care and other local services?
  • Should the police continue to implement the Right Care, Right Person model? Do mental health services have sufficient resource and capacity to bridge the gap?
  • Should drug diversion schemes be rolled out across England and Wales? Do drug treatment services have sufficient capacity and resource to respond to increased demand on services?
  • Should the government go further in taking a public health approach to drugs by decriminalising drug possession for personal use?
  • How effective have government measures to reduce youth violence been?
  • What international comparisons are useful for implementation of public health approaches to policing?

 

Source: DOI: https://doi.org/10.58248/HS62

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/

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.govwww.cdc.govwww.drugfree.orgteenshealth.org/teenwww.drugfreeactionalliance.org/knowcombatheroin.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

Abstract

Background

Youth in disadvantaged socio-economic circumstances in South Africa face significant risks to their physical and mental well-being due to exposure to harmful behaviours. More than 50% of the global disease burden is attributed to non-communicable diseases linked to such behaviours. While interventions have been initiated to address these risks, the limited reduction in risky behaviour necessitates closer examination and the exploration of more targeted or innovative approaches for effective mitigation.

Objectives

To explore existing health risk behaviour prevention/intervention programmes targeting youth, focusing on decreasing risky behaviour engagement and to discuss the success of the intervention used.

Methods

Three electronic databases were searched from 2009 until November 2023. Studies specifically reported using an intervention programme in youth or adolescents aged 9 to 19 were included. Data extracted included age, grade, sample size, targeted risky behaviour, and outcome.

Results

A total of 1072 articles were screened across three major databases, and of the nine included studies, n = 7 yielded mild to moderate intervention success results. The use of incentives yielded unsuccessful results. The most successful intervention strategy identified was school-based intervention programmes targeting multiple risky behaviours.

Conclusion

School interventions combining counselling, electronic screening, and personalized feedback effectively modified behaviour, while incentive-based programs had minimal impact. This underscores the importance of targeted interventions to discourage risky behaviour among young people.

Clinical implications

Effective intervention and prevention programs targeting health risk behaviours in youth are essential in safeguarding their mental and physical well-being. A clear link between risky behaviour engagement and the potential development of non-communicable diseases or trauma should be emphasised.
The full article can be accessed by clicking on the Source link below:
Source: https://www.springermedizin.de/health-risk-behaviour-prevention-intervention-programmes-targete/27472880
Dr. Robert DuPont (NIDA, USA) shifted the paradigm from demonization to treatment of users.

Key points

  • In the 1970s, people addicted to opioids were demonized, considered hopeless. Some still believe this.
  • Setting high standards and following addicted patients for five years helps doctors know what treatments work.
  • Prevention is key to success in substance abuse, and it’s important to encourage non-use among teens.
In the United States, people addicted to opioids were once demonized as hopelessly bad, and treatment was virtually nonexistent. No one may have done more to change both matters than psychiatrist Robert DuPont, M.D, who, in 1969, during an unexplained surge in crime in the nation’s capital, was working with prisoners in the District of Columbia Department of Corrections. DuPont decided to test incoming inmates for drugs and was shocked to learn that nearly half (45%) were addicted to heroin. Desperate for heroin, they turned to crime for money.

At the behest of the district’s mayor, DuPont developed a D.C.-based clinic, the Narcotics Treatment Administration. It treated more than 15,000 heroin addicts over the next three years, and the D.C. crime rate plummeted by 50%, in a direct correlation.

Helping Medical Professionals Do Better

Robert L. “Bob” DuPont, born in 1936, graduated from Emory University and Harvard Medical School and completed his psychiatric training at the National Institutes of Health. He became the first director of the newly-created National Institute on Drug Abuse (NIDA), where he created a first-of-its-kind comprehensive training program for doctors, nurses, and counselors working in addiction treatment programs. Drug overdose deaths began declining, from from 6,413 to 2,492 by 1980.

In 1978, DuPont left government service to create the Institute for Behavior and Health (IBH), a think tank focusing on drug policy. Dupont has published more than 400 journal articles and 15 books, most recently Chemical Slavery: Understanding Addictions and Stopping the Drug Epidemic (2018).

The IBH conducted the first national study of doctors dependent on drugs and alcohol, their treatment, and five-year outcomes. “Physicians are given a comprehensive assessment by a team of professionals and get treatment for comorbidities, but the focus is on their addictions. They typically attend a month or more of residential treatment and, as outpatients, are monitored for five years with random drug and alcohol testing. If they miss a scheduled test or test positive for any drug, including alcohol, they are taken out of their practice again, assessed, and sent back to treatment.”

DuPont points out that many doctors who entered the program were initially resentful because they didn’t think there was anything wrong with them—typical of individuals with substance use disorder from all walks of life. Yet, most physicians greatly value their medical license, and the overwhelming majority cooperated because participation and success meant they could continue to practice medicine.

His study of nearly 1,000 drug-addicted physicians closely monitored for five years showed what is possible for the rest of the population. Seventy-eight percent never tested positive for drugs or alcohol, an excellent record. In addition, of those who did have a positive or missed drug test, nearly two-thirds never had a second positive test.

A follow-up study of physicians who successfully completed treatment and monitoring contracts five or more years ago showed that more than 95% were still in recovery. Physicians rated the treatment they had received as important to their recovery but said the most valued part of their care was involvement in the 12 steps.

Lessons Learned About Substance Abuse

DuPont says many people don’t realize that it’s rarely just one drug abused by most problematic substance users. And that is particularly true of individuals who die from drug overdoses, in whom two or more drugs are often identified post-mortem.

He also notes that many drugs used today are not in their natural forms but instead are ultra-potent synthetics, like fentanyl. In 2022, about 111,000 people died, and in 2023, about 108,300 people died of drug overdose. .

Early diagnosis and treatment is key

The earlier patients are diagnosed and treated, the better their chances of achieving and sustaining recovery, says DuPont. Many people can stop using substances for some period. However, the real problem is not drug withdrawal, as many people believe, but, instead, the repeated relapses. Yet he has known many individuals with seemingly hopeless drug or alcohol issues who emerged sober and productive. He largely credits organizations like Alcoholics Anonymous and Narcotics Anonymous.

Prevention is best

Whenever possible, prevention of drug use is best, particularly among young people. Not only is adolescence a time when most addictions begin, it’s also a time when the brain is uniquely vulnerable..

DuPont now focuses on youth substance-use prevention: no alcohol, nicotine, marijuana/THC, or other drugs by those under age 21. He notes that the percentage of 12th graders who report never using in their lifetime has increased from around 26% in 2018 to 32% in 2023. The trend is also evident in younger students. DuPont emphasizes, “This trend is key to reversing decades of pain, suffering, and addictions.“

At age 88, Robert DuPont, M.D., advocates for treatment research, long-term treatment with outcome reporting, mental health treatment parity (as important as physical health), and prevention. Recovery, he insists, is possible.

About the Author

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

Source: https://www.psychologytoday.com/gb/blog/addiction-outlook/202408/a-front-row-change-agent-of-the-drug-epidemic
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

Tricia Otto’s son, Calvin, will forever be 29 years old. That’s because he lost his life to fentanyl poisoning at age 29 in April of last year.

“He was funny. He had an amazing sense of humor. He was thoughtful. He was kind. He always worried about how other people were feeling. Um, he struggled with addiction for about 14 years, but he fought really hard against that,” Tricia Otto explains. “He always talked about wanting to be a fireman … And instead of fighting fires, my son spent his time fighting demons.”

In 2023 alone, there were over 1, 200 drug overdose deaths from fentanyl in Colorado.

That’s according to the Common Sense Institute. That equates to roughly three deaths per day on average. This upcoming Wednesday, August 21st, is National Fentanyl Prevention and Awareness Day. It was started by the nonprofit Facing Fentanyl. They’re organizing a takeover of Times Square in New York City this week.

Here in Colorado, there will be a Candlelight Vigil at the Denver City and County Building this Wednesday at 7 p. m. (flyer posted below).

Tricia Otto, in addition to being Calvin’s mom, is the Drug-Induced Homicide Foundation Colorado Chapter State Representative. She joined KGNU’s Jackie Sedley to discuss how important it is to talk about fentanyl poisoning, to use language that takes blame off of those with substance use disorder, and to hold those who sell illicit substances accountable.

“Referring fentanyl poisoning as an accidental overdose diminishes the calculated greed and disregard for human life that led to this tragic, tragic passing,” Otto says. “Those struggling with substance abuse disorder are targeted and exploited by drug dealers and others who stand to profit from their vulnerability. Calling it an accident ignores the deliberate actions of those that prey on the addicted, pushing dangerous substances for their own gain. This is not an unfortunate mishap. It’s a calculated act of malice that leads to the death and devastates families.”

Source: https://kgnu.org/fentanyl-overdose-prevention-awareness-triciaotto-calvinotto/

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 marijuanacocainehallucinogens, 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/

In a significant move towards strengthening drug prevention initiatives in Pakistan, the First Meeting of the National Narcotics Control Committee (NNCC) witnessed notable mentions of the Karim Khan Afridi Welfare Foundation (KKAWF). Constituted under the National Anti-Narcotics Policy 2019 by the Ministry of Narcotics Control, the NNCC aims to consolidate and coordinate nationwide efforts against narcotics. The KKAWF’s impactful work in drug prevention and awareness among the youth has been prominently recognized, reflecting the foundation’s growing influence and contribution to this critical issue.A particularly commendable mention was made in a letter from the Ministry of Federal Education and Professional Training, highlighting the inclusion of KKAWF’s ‘Hum Sath Hain’ prevention program. This innovative initiative has already made substantial strides in combating drug abuse at the grassroots level. Over 300 teachers from public schools have been trained under this program, equipping them with the necessary skills and knowledge to educate and guide their students about the dangers of drug abuse. These trained educators are now actively implementing the ‘Hum Sath Hain’ program in their respective schools, directly impacting thousands of students and fostering a drug-free culture among the youth.

The Ministry’s letter, which was attached to the Minutes of the First Meeting of the NNCC, further highlighted the certification of three Master Trainers from the Federal Directorate of Education (FDE) by KKAWF. This certification is a testament to the foundation’s commitment to quality and sustainable training programs.

The Foundation’s efforts were not only acknowledged through official documentation but also received commendation from key figures at the meeting. The Director General of Excise, Taxation and Narcotics Control Punjab, who was among the participants, praised KKAWF’s relentless efforts in drug prevention. This recognition from a high-ranking official underscores the importance and effectiveness of KKAWF’s initiatives.

KKAWF has consistently been at the forefront of drug prevention and awareness in Pakistan, focusing on educating young people about the dangers of drug use. The foundation’s programs are designed to address the root causes of drug abuse, providing youth with the tools and support they need to make informed choices. By collaborating with schools and educational institutions, KKAWF ensures that its messages reach young people in a structured and impactful manner.

The mention of KKAWF at the NNCC meeting signifies a broader acceptance and endorsement of its programs at the national level. Such recognition not only validates the foundation’s hard work but also provides it with a platform to expand its reach and influence. It opens doors for more collaborations with government bodies, educational institutions, and other stakeholders, thereby enhancing the collective efforts against drug abuse in the country.

In conclusion, the First Meeting of the National Narcotics Control Committee marked a significant milestone for the Karim Khan Afridi Welfare Foundation. The inclusion of their ‘Hum Sath Hain’ program in the official records, along with commendations from high-ranking officials, highlights the foundation’s vital role in drug prevention. As KKAWF continues to expand its initiatives and impact, it sets a commendable example for other organizations working towards a drug-free Pakistan.

Source: https://www.dianova.org/news/unite-for-a-drug-free-pakistan/

12 Aug 2024

Substance abuse disorders are on the rise among young people. The American Addiction Center reports one in seven young adults are affected. Crisis coach Scott Silverman and youth drug prevention educator Rocky Herron joined the CBS 8 Morning Show with details.

Source: https://www.youtube.com/watch?v=K6BYoWOnAG8

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

Effort aims to elevate Indigenous knowledge and culture in research, to respond to the overdose crisis and address related health disparities

The National Institutes of Health (NIH) has launched a program that will support Native American communities to lead public health research to address overdose, substance use, and pain, including related factors such as mental health and wellness. Despite the inherent strengths in Tribal communities, and driven in part by social determinants of health, Native American communities face unique health disparities related to the opioid crisis. For instance, in recent years, overdose death rates have been highest among American Indian and Alaska Native people. Research prioritized by Native communities is essential for enhancing effective, culturally grounded public health interventions and promoting positive health outcomes.

“Elevating the knowledge, expertise, and inherent strengths of Native people in research is crucial for creating sustainable solutions that can effectively promote public health and health equity,” said Nora D. Volkow, M.D., director of NIH’s National Institute on Drug Abuse (NIDA). “As we look for ways to best respond to the overdose crisis across the country, it is crucial to recognize that Native American communities have the best perspective for developing prevention and therapeutic interventions consistent with their traditions and needs. This program will facilitate research that is led by Native American communities, for Native American communities.”

Totaling approximately $268 million over seven years, pending the availability of funds, the Native Collective Research Effort to Enhance Wellness (N CREW) Program will support research projects that are led directly by Tribes and organizations that serve Native American communities, and was established in direct response to priorities identified by Tribes and Native American communities.

Many Tribal Nations have developed and continue to develop innovative approaches and systems of care for community members with substance use and pain disorders. During NIH Tribal Consultations in 2018 and 2022, Tribal leaders categorized the opioid overdose crisis as one of their highest priority issues and called for research and support to respond. They shared that Native communities must lead the science and highlighted the need for research capacity building, useful real-time data, and approaches that rely on Indigenous Knowledge and community strengths to meet the needs of Native people.

The N CREW Program focuses on:

  1. Supporting research prioritized by Native communities, including research elevating and integrating Indigenous Knowledge and culture
  2. Enhancing capacity for research led by Tribes and Native American Serving Organizations by developing and providing novel, accessible, and culturally grounded technical assistance and training, resources, and tools
  3. Improving access to, and quality of, data on substance use, pain, and related factors to maximize the potential for use of these data in local decision-making.

“Native American communities have been treating pain in their communities for centuries, and this program will uplift that knowledge to support research that is built around cultural strengths and priorities,” said Walter Koroshetz, M.D., director of NIH’s National Institute of Neurological Disorders and Stroke (NINDS). “These projects will further our collective understanding of key programs and initiatives that can effectively improve chronic pain management for Native American and other communities.”

The first phase of the program will support projects to plan, develop, and pilot community-driven research and/or data improvement projects to address substance use and pain. In this phase, NIH will also support the development of a Native Research Resource Network to provide comprehensive training, resources, and real-time support to N CREW participants.

The second phase of the program, anticipated to begin in fall 2026, will build on the work conducted in the initial phase of the program to further capacity building efforts and implement community-driven research and/or data improvements projects. Additional activities that support the overarching goals of the N CREW Program may also be identified as the program develops.

The N CREW Program is led by the NIH’s NIDA, NINDS, and National Center for Advancing Translational Sciences (NCATS), with participation from numerous other NIH Institutes, Centers, and Offices. The N CREW Program is funded through the NIH Helping to End Addiction Long-term Initiative (or NIH HEAL Initiative), which is jointly managed by NIDA and NINDS. For the purposes of the N CREW Program, Native Americans include American Indians, Alaska Natives, and Native Hawaiians. Projects will be awarded on a rolling basis and publicly listed.

This new program is part of work to advance the President’s Unity Agenda and the HHS Overdose Prevention Strategy.

Source:  https://nida.nih.gov/news-events/news-releases/2024/08/nih-launches-program-to-advance-research-led-by-native-american-communities-on-substance-use-and-pain

Dr. David R. Holtgrave, Ph.D., Joins the Department of Health as Senior Policy Advisor to the Commissioner to Enhance the Department’s Mission to End the Opioid Epidemic

ALBANY, N.Y. (August 15, 2024) – The New York State Department of Health is pleased to welcome nation-leading public health, prevention and substance use policy expert Dr. David R. Holtgrave, Ph.D., to the executive leadership team as Senior Policy Advisor to the Commissioner. Dr. Holtgrave joins the State Health Department with more than 35 years of public health experience, including serving in the White House Office of National Drug Control Policy from 2022-2024.

“Dr. Holtgrave is a national leader in drug prevention programs and a public health expert who comes to the State Health Department to help our fight against the overdose epidemic,” State Health Commissioner Dr. James McDonald said. “I’m thrilled to welcome Dr. Holtgrave to the executive leadership team, as we continue to rebuild the Department and hire experienced, compassionate public health experts.”

Dr. Holtgrave joins the Department with decades of experience addressing urgent public health issues, demonstrated by his development of an evidence-based national response plan to confront the emerging challenge of fentanyl combined with xylazine in the illegal drug supply, his rapid research to inform COVID-19 clinical decision making and his transitional work in addressing HIV-related health inequities in the U.S.

At the Department of Health, Dr. Holtgrave is charged with a range of activities all with the common theme of translating data into the best possible public health programs and policies for the residents of New York. In particular, he will focus on facilitating the substance use work in the Department to ensure that it is as coordinated, evidence-based and impactful as possible.

“I am honored and humbled by Commissioner McDonald’s invitation to join in the impactful work being done at the Department of Health,” Senior Policy Advisor to the Commissioner Dr. David Holtgrave said. “As the Department is committed to improving the health and well-being of all New Yorkers and building health equity across the State, I am delighted to be able to serve on this incredible team.”

Prior to his service in the White House Office of National Drug Control Policy, Dr. Holtgrave served as the Dean of the University at Albany School of Public Health and worked in close partnership with the New York State Department of Health.

From 2005 to 2018, he was the Chair of the Department of Health, Behavior, and Society at the Johns Hopkins Bloomberg School of Public Health, and served as a member and then Vice-Chair of the Presidential Advisory Council on HIV/AIDS (PACHA). His experience includes service as the Director of the Division of HIV/AIDS Prevention – Intervention Research & Support at the U.S. Federal Centers for Disease Control and Prevention (CDC); and as Professor and then Vice-Chair of the Department of Behavioral Sciences and Health Education at the Emory University Rollins School of Public Health.

A first-generation college student, Dr. Holtgrave earned his Ph.D. in 1988 from the University of Illinois at Urbana/Champaign in Quantitative Psychology and immediately thereafter held a post-doctoral research fellowship in the Interdisciplinary Programs in Health at the Harvard T.H. Chan School of Public Health.

Source: https://www.health.ny.gov/press/releases/2024/2024-08-15_executive_leadership.htm

School-based interventions hold the potential to save lives, researchers say.

Charlotte WaddellChristine SchwartzJen Barican and Nicole Catherine 16 Aug 2024The ConversationCharlotte Waddell is a professor emerita of health sciences at Simon Fraser University, where Christine Schwartz is an adjunct professor and Nicole L.A. Catherine is a professor. Jen Barican is a senior research manager at SFU. This article was originally published by the Conversation.

Successful drug prevention programs delivered to middle-school students taught skills such as resisting peer pressure, managing stress and cultivating positive friendships. Illustration via Shutterstock.

Can a program for Grade 7 students help end the opioid crisis? The answer is yes, according to compelling research findings on school-based primary prevention interventions.

To address this crisis, many of Canada’s responses to the opioid crisis still focus downstream on adults, after problems have started or become entrenched.

In contrast, primary prevention operates upstream in childhood — before most young people start engaging in substance use, misuse or experimentation.

As researchers concerned with helping children avoid opioid misuse, we conducted a systematic review of prevention programs designed for this purpose.

Interventions that could save lives

The program Strengthening Families significantly reduced prescription opioid misuse among young people in Iowa and Pennsylvania, with benefits lasting up to 14 years after the program ended.

The impact was also large, reducing misuse by 65 per cent.

Project PATHS, the other successful program, which was delivered in Hong Kong, significantly reduced heroin use with benefits lasting up to two years later. And each time these programs prevented a young person from misusing opioids, they potentially saved a life.

Beyond intervening early, both of these successful programs shared other similarities. Children learned enduring skills such as resisting peer pressure, managing stress and cultivating positive friendships.

Teaching multiple skills that children could apply throughout their development likely played a role in the programs’ long-term success — and likely contributed to other positive outcomes including reducing cannabis and ecstasy use.

Both program evaluations also highlighted the ability to reach very large numbers of children, using school delivery. These numbers were about 12,000 for Strengthening Families and about 8,000 for Project PATHS.

These numbers suggest that new Canadian school-based prevention efforts could potentially reach thousands of young people. With such a substantial population impact, these programs hold great promise to reduce many harms associated with the opioid crisis — including not only deaths but also criminal activity and distress for individuals misusing opioids and their families.

These two school-based programs have another significant feature adding to their appeal for delivery in Canada. Training for facilitators is very brief — only two days for Strengthening Families and three days for Project PATHS.

The short training time also helps reduce delivery costs, further increasing the appeal for policymakers and school administrators.

In Canada, we need such programs. And evaluations

Yet program benefits do not always translate between countries. So Canadian evaluations would be an important component to accompany implementation of either or both programs.

PreVenture, a school-based program developed by a clinical psychologist and researcher at the University of Montreal, is a good example of expanding both prevention and evaluation efforts.

Researchers from across Canada are currently assessing whether this program can avert opioid use with youth in British Columbia, Ontario and Nova Scotia — building on its success with decreasing alcohol problems as well as the number of drugs that youth used in an RCT in the United Kingdom.

If successful, PreVenture could also be expanded so that fewer Canadian children experience the devastating effects of the opioid crisis.

Research has highlighted important gains that Canadians can achieve by investing in school-based prevention programs.

To realize these benefits, however, leadership is needed at the provincial and territorial levels given that schools fall within these jurisdictions.

Yet the federal government can also take strong leadership, for example, encouraging these types of primary prevention efforts across the country — as they have done with previous important child health problems.

Prevention needs to be central to the approach

The federal government has committed more than a billion dollars since 2017 to address the toxic drug problem — paralleled by provincial and territorial funding.

But a policy shift towards meaningful prevention also requires tackling the realities of current Canadian health spending priorities. While last November, the federal government called for proposals for “projects aimed at helping prevent and decrease substance use-related harms among young people,” such efforts need to be backed by rigorous evaluation methods such as RCTs.

And the programs we describe above have RCT support — suggesting that these are a place to start.

Devastation from the opioid crisis is obviously continuing. Efforts to respond to the acute crisis must therefore also continue — including ensuring access to effective treatments for all in need and curtailing the supply of toxic substances.

But primary prevention also needs to be central in the public health responses, given that continuing increases in treatment spending have not been enough and will likely never be enough on their own. Primary prevention is a crucial but underused component of a comprehensive public health approach.

Most importantly, new primary prevention efforts can increase the chances of more young people experiencing the healthy development that they deserve, in turn precluding much suffering and many costs later in life — while meeting the collective duty of care that all Canadians share for all children.The Conversation

Source: https://www.thetyee.ca/Analysis/2024/08/16/Programs-Youth-Toxic-Drug-Deaths/

August 4, 2024

Lifestyle changes—including eating fruits, vegetables, and whole grains—can help patients, especially those with diabetes or hypertension, improve outcomes.

Robert Ostfeld, MD, ScM, director of preventive cardiology at Montefiore Health System and professor of medicine at Albert Einstein College of Medicine in New York sat down with Drug Topics ahead of the American Society for Preventive Cardiology Congress on CVD Prevention to discuss the role that dietary patterns and nutrition decisions play in living a healthful lifestyle.

Drug Topics: What specific nutrients or dietary patterns have been shown to benefit patients with hypertension and diabetes, and how can this information be incorporated into patient counseling?

Robert Ostfeld, MD, ScM: That’s a very important question. A healthful diet, of course, can very positively impact cardiometabolic health—including blood pressure, diabetes, [and] lipids—and cardiovascular health and overall health in general.

Reassuringly, there is broad [alignment] in terms of what defines a healthful dietary pattern. For example, multiple medical societies—like the American Heart Association, the American College of Cardiology, the American Society for Preventive Cardiology, the Canadian Cardiovascular Society, the European Society of Cardiology—are all broadly aligned; consuming more plant-based nutrition, less ultra-processed foods, less red and processed meats, is helpful both cardiometabolically and [for] cardiovascular health overall.

Unfortunately, that recommendation hasn’t necessarily percolated down well, at least into the US. There was an interesting recent analysis where from the NHANES database—the National Health and Nutrition Examination Survey database—published in 2021, where they looked at a little over 11,000 people…where they used 5 elements to define diet. One element was consuming at least 4 and a half servings of fruits and vegetables a day, at least 3 servings of whole grains each day, low sugar or sweetened beverage consumption, low salt consumption, and 2 servings of fatty fish each week. If you had 0 or 1 of those, then they felt you had a poor diet; 2 or 3 an intermediate [diet], and 4 or 5, an ideal dietary pattern. About 75% of the US has a poor, 0 to 1 of those [elements] dietary pattern; 25% [have] intermediate, and 0.7% of the US has an ideal dietary pattern.

READ MORE: Food Is Medicine: Pharmacists Can Advance Policies for Healthier Communities

There’s a huge gap between where we are and where we could. You could ask, “Does it even really matter?” Of course it does. In this study, they modeled if everyone adopted an ideal dietary pattern—so 4 or 5 of those 5 elements—for 1 year, what would happen? Well, it was estimated that cardiovascular event rates would fall by about 42%. The gap matters. There’s randomized prospective cohort data that eating a healthful dietary pattern, more plant based [and] aligned with American College of Cardiology and American Heart Association recommendations, can also be helpful for high blood pressure, particularly the DASH [Dietary Approaches to Stop Hypertension] dietary pattern for high cholesterol, the dietary portfolio pattern, which is a high fiber plant based diet, and also, similar recommendations broadly for diabetes.

What I should reinforce is, it’s not really that there’s 1 diet for high blood pressure, high cholesterol, and diabetes. They’re really broadly aligned that consuming more healthful, plant-based foods—fruits, vegetables, whole grains, beans, lentils—less ultra-processed foods and less red and processed meats, is helpful for all of the above: cardiovascular health and cardiometabolic health.

Drug Topics: How can patients be supported in overcoming common barriers to healthy eating, such as budget constraints and limited access to nutritious foods, in the management of hypertension and diabetes?

Ostfeld: Helping the individual patient in the office embrace a more healthful diet can be a challenge. Society does not make…it easy for the healthy choice to be the easy choice. And behavior change, getting someone to change how they eat, how they live, can be very, very difficult. These are big hurdles that we face.

As an individual practitioner, it can be overwhelming to overcome some of these things; at least we can try and start. As an individual [health care provider], you’ll have your team around you who can support you and reinforce your message. Nurses, support staff, and registered dietitians can be incredibly helpful to reinforce and educate about this topic.

In the clinic specifically, I will try to find a specific reason that the patient may be interested in living more healthfully. Maybe they want to lose weight or improve their skin complexion, maybe they want to lower their blood pressure, lower their cholesterol, come off a medication… Whatever the case may be, I try to highlight how consistently eating more healthfully can address that particular issue. I will give them some very specific steps—some simple specific steps, because everyone’s busy and there’s so much information to take in—that they can hopefully do when they get home to live more healthily. I have a handout that I give them that I try to keep very simple.

Sometimes in clinic, because we’re all so busy, I’ll just say, “Let’s just start with 222.” [That’s] 2 servings of green leafy vegetables a day, 2 servings of fruit each day, 2 servings of other vegetables each day: 222. I’ll do that a little bit weirdly, deliberately, so they’ll remember it. Then when they go home, depending on where they live, there may be more or [fewer] access or cost issues. [I’ll explain that] for ease, [they] could cook in bulk; we certainly don’t have to buy, you know, organic green juices. You can get frozen vegetables, frozen fruits, big sacks of potatoes, oatmeal, and beans, and those things can be much less expensive and more doable.

Another way to help patients adopt a more healthful lifestyle is—there may be the hurdle of costs here—but there are services that can deliver meals, healthful meals, to patients; they may be able to access registered dieticians, and of course there are multiple online resources that are free for patients. The Physicians Committee for Responsible Medicine has a 21-day kickstart for more plant-based nutrition should, the [health care provider] feel that that’s appropriate for the patient. There are a variety of resources that people can have access to; some may cost a little bit more, but some are also free. The American College of Lifestyle Medicine also has multiple online resources.

Source: https://www.drugtopics.com/view/q-a-examining-the-key-drivers-of-a-healthful-lifestyle

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

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

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

 

Mothers of children who died via fentanyl poisoning champion NC’s new death-by-distribution law and continue to advocate for awareness

BY GALE MELCHER   The CityBeat 

JULY 20TH, 2024

On a billboard off of Battleground Avenue in Greensboro, 20 smiling faces flash grins through the screen — smiles that will forever be contained in pictures and their families’ memories. All 20 people pictured on the billboard passed away after taking drugs they didn’t know were laced with fentanyl, a synthetic opioid drug that is being mass-produced and added to other illicit drugs to increase their potency. This often results in death — in North Carolina, 183 deaths occurred this March.

Next to the faces a message reads: “Hidden in so-called ‘recreational’ drugs, fentanyl steals families.”

On July 6 around noon, families gathered around Elizabeth’s Pizza facing the billboard to remember their loved ones and raise awareness about the dangers of illicit drugs.

Deborah Peeden lost her granddaughter Ashley in October 2021 and shared her story with TCB last year.

In 2023, the Drug Enforcement Administration seized more than 80 million fentanyl-laced fake pills. This year, that number has reached more than 28.1 million and is still climbing. Additionally, seven out of 10 pills seized by the DEA contain lethal doses of fentanyl.

 

Deborah Peeden stands next to an image of her granddaughter, Ashley, who thought

she was doing cocaine with friends when she died from fentanyl poisoning at age 23.

(Photo by Gale Melcher)

In an interview, Peeden said that she felt it was important to put the billboard up to highlight the memory of locals lost to fentanyl. For the past two years, Peeden has paid for a billboard in memory of Ashley. Peeden is now an ambassador for Facing Fentanyl, a campaign that provides prevention education and opioid-reversal kits to schools.

“Some days I’m good, and other days it just hits out of the blue,” Peeden said. “She’s on my mind 24/7 every single minute of every single day. She’s got her birthday coming up on August 1.”

Peeden explained that when dates like birthdays come around, she “can feel that tsunami wave coming.”

“You feel like you’re drowning,” she said.

On July 6, TCB spoke with other mothers who have lost their children to fentanyl poisoning;  TCB is not publishing their names as their childrens’ cases are still active. Many of the families have connected via support groups and bonded over their losses. One mother tugged at the layers of colorful bracelets on her wrist before finding the name of Thomas Lamb etched into a plastic bracelet. Thomas died from fentanyl poisoning in September 2022. She’s friends with Thomas’s mother, Amy Lamb, who still celebrates his birthday every year with his friends and family.

 

A bracelet etched with the name of Thomas Lamb. In September 2022, Thomas, age 18,

purchased a pill to help him sleep; he thought it was Xanax. It was fentanyl.

(Photo by Gale Melcher)

A small child bobbed through the crowd, stopping to point at their loved one’s face on the billboard and shout out their name. Some of the families are hopeful that they will be able to see some form of justice through North Carolina’s death-by-distribution law, passed in 2019 and recently updated on Dec. 1.

The older version of the law stated that a person is guilty of death by distribution if all of the following requirements are met: the person unlawfully sold at least one controlled substance such as an opioid, cocaine or methamphetamine, that the substance they sold caused the death of the user and that the person who sold the drug did not act with malice. The crime was a Class C felony, which usually results in a 5-12 year prison sentence with a maximum sentence of 19 years.

The updated version of the law removes the malice requirement or proof that the drug was sold. Under the new law, perpetrators can be charged with a Class C felony if they simply distribute a drug such as methamphetamine, fentanyl or cocaine that leads to a victim’s death. If the perpetrator did act with malice, they could be charged with a Class B2 felony.

In an email to TCB, the Greensboro Police Department’s Public Information Coordinator Patrick DeSota explained that in response to the updated law, the police department “instituted internal procedural changes in [their] response to suspected overdose deaths” in an effort to further these types of investigations. DeSota added that they have implemented screening questions specific to suspected overdose investigations.

Peeden was a vocal critic of GPD and the way they handled Ashley’s case, and said she’s “glad” the law has been updated.

“I’m hoping that that will make a big difference,” Peeden said. “With Ashley’s case, they just never did anything with hers. Nothing more than a police report.”

 

Posters warn of the dangers of fentanyl.

(Photo by Gale Melcher)

Still, communications specialist for Guilford County Sheriff’s Office Bria Evans wrote that the change in law “does not directly affect [their] investigative procedures” but that it does “make it easier for [them] to criminally charge individuals” because they no longer have to “prove the actual ‘sell’ of the substance.”

Another anonymous mother TCB spoke to said that she hopes the updated law will send “shockwaves” to drug dealers, reverberating the message that selling drugs could have serious consequences.

One silver lining is that NC deaths from fentanyl appear to be declining according to data collected by the state Department of Health and Human Services. Since December, which totaled 264 deaths, monthly deaths have dropped to 220 in January, 207 in February and 183 in March. And awareness of the drug is key, Peeden explained.

“It can happen to anybody’s child, and if you don’t think it can happen to you, think again,” Peeden said.

And while Peeden and the other families have been advocating for their loved ones for years, the pain “doesn’t get easier,” she said.

“I’ve had someone tell me ‘Debbie, you’ve done enough, just stop, you’ve done enough, you need to quit.’ I’m like no, I can’t quit,” Peeden said. “We’ve got too many kids out there who don’t know, we have too many parents out there that don’t know, and we want to try to save the lives of other kids so that these parents go through the nightmare that we’re going through.”

 

Thomas Lamb, who died in September 2022 from fentanyl poisoning,

will forever be 18 to his family and friends.

(Photo by Gale Melcher)

 

Source: Gale Melcher, Citybeat Reporter (She/They) gale@triad-city-beat.com

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

Key topics

 

Overdose prevention services should be offered through HIV care

National Institute on Drug Abuse Director Nora Volkow explains the need to leverage the successes of HIV care to prevent overdose deaths. HIV and substance use are inextricably linked. An analysis of the New York City HIV surveillance registry found that in 2017, rates of overdose deaths for people with HIV were more than double overall overdose death rates for the city, but that 98% of those who died of overdose had been linked to HIV care after their HIV diagnosis and that more than three-quarters had been retained in care. This highlights an overlooked opportunity to save lives. Drug overdose claims more lives of people with HIV than HIV-related illness. Volkow says 81% of people who received an HIV diagnosis in 2019 in the U.S. were linked to HIV care within a month, 66% received care and 50% were retained in care. It is sometimes hard to reach people who use drugs with substance use treatment or harm reduction, but when people with HIV seek and receive treatment for HIV, it presents a promising opportunity to deliver addiction services. Delivering naloxone and overdose education in HIV care settings is a relatively easy way to prevent overdose deaths.

 

Hemp legalization opened the door to intoxicating products

Lawmakers who backed hemp legalization in the 2018 Farm Bill expected the plant to be used for textiles and nonintoxicating supplements. They did not realize that, with some chemistry, hemp can get you high. People anywhere in the U.S. can use hemp-derived THC without breaking federal law. Hemp and marijuana are varieties of the same plant species. Marijuana is defined by its high content of delta-9 THC. Hemp contains very little delta-9 THC but can contain a large amount of CBD, a cannabinoid that does not get you high. The Controlled Substances Act explicitly outlawed both hemp and marijuana. The Farm Bill defines hemp in a way that allows the plant and products made with it as long as they contain less than 0.3% delta-9 THC, making it seemingly legal to convert CBD into delta-8 THC as long as the process started with a plant that contained less than 0.3% delta-9 THC. The Farm Bill also appears to authorize the creation of hemp-based delta-9 THC products as long as the total delta-9 content is 0.3% or less of the product’s dry weight. The hemp-derived cannabinoid industry is now worth billions of dollars, and hemp-derived intoxicants are available at vape shops and gas stations, but they are not regulated.

 

Federal news

 

Expanded access to methadone is needed

National Institute on Drug Abuse Director Nora Volkow highlights the need to expand access to methadone. Only a fraction of people who could benefit from medications for opioid use disorder receive them, due to a combination of structural and attitudinal barriers. In 2023, the federal government eliminated the waiver requirement for buprenorphine. This year, it changed methadone regulations to make permanent the increased take-home doses of methadone established during the COVID emergency, along with other provisions aimed to broaden access. Changes implemented during COVID have not been associated with adverse outcomes, and patients reported significant benefits. Recent trials of models of methadone dispensing in settings other than methadone clinics have not supported concerns that making methadone more widely available will lead to harms. Data suggest that counseling is not essential for reducing overdoses or retaining patients in care, though it can be beneficial for some. It will also be critical to pursue other ways that methadone can safely be made more available to a wider range of patients.

 

CDC defends overdose prevention work before House committee

Several top Centers for Disease Control and Prevention (CDC) officials testified before the House Energy and Commerce Committee to defend their agency’s programs. The hearing comes after House Republicans passed a budget that would cut CDC funding by 22%. Republicans claimed the agency has failed to fulfill its responsibilities and lost the public’s trust. Republicans accused the CDC of straying from its core mission of keeping the public healthy and said the agency is spending too much time on programs some GOP lawmakers deemed unnecessary or duplicative. The CDC program directors pushed back, citing work they deemed critical to public health. They emphasized three areas of focus – improving readiness and response to disease outbreaks, improving mental health and supporting young families. Allison Arwady, director of the National Center for Injury Prevention and Control, which would be eliminated under the proposed funding bill, spoke about why the center’s work on overdose prevention is necessary.

Source: CDC Defense (Politico); CDC fields GOP criticism at E&C hearing (Politico)

 

Task force releases recommendations to protect youth from social media harms

The federal Kids Online Health and Safety Task Force released a report with recommendations and best practices for safer social media and online platform use for youth. The report provides a summary of the risks and benefits of social media on the health, safety and privacy of young people; best practices for parents and caregivers; recommended practices for industry; a research agenda; and suggested future work, including for the federal government. In collaboration with the Task Force, the Center of Excellence on Social Media and Youth Mental Health is launching a variety of new web content, including best practices resources; age-based handouts for parents that pediatricians and others can distribute at well-check visits; new clinical case examples for pediatricians and other clinicians demonstrating how to integrate conversations about media use into health consultations with teens; and expanded content for teens. The report outlines 10 recommended practices for online service providers.

 

FDA allows sale of tobacco-flavored Vuse e-cigarettes

The Food and Drug Administration (FDA) authorized sales of certain tobacco-flavored Vuse Alto e-cigarette products from R.J. Reynolds. Vuse is the top-selling e-cigarette brand in the country, comprising more than 40% of the market. The marketing authorization applies to six tobacco-flavored pods, which are sealed, prefilled and nonrefillable. Last year, the FDA banned the sale of Vuse Alto menthol and fruit-flavored e-cigarettes, citing increasing popularity among kids.

 

State and local news

 

Montana plans to install harm reduction vending machines

Montana health officials are considering a new strategy to make naloxone more accessible. Drawing on a pool of behavioral health funds set aside by lawmakers in 2023, health officials have proposed installing two dozen naloxone and fentanyl test strip vending machines around the state at behavioral health drop-in centers and service locations for homeless people. The $400,000 plan to build, stock and maintain 24 vending machines for a year has not yet been approved by the governor. Different versions of the harm reduction vending machine model are being tried in at least 33 states, becoming increasingly popular especially in places with hard-to-reach populations. Some local public health groups in Montana have already begun using vending machines to distribute free naloxone, drug testing strips and other supplies, using public grants or private philanthropy, but these would be the first vending machines in Montana being directly funded by the state.

 

Iowa providing $13 million to expand addiction treatment and recovery housing

Iowa Governor Reynolds announced that the state’s opioid treatment and recovery providers can begin applying for $13 million in grants to expand or improve facilities or develop sober living housing options. The funding opportunities were announced in May as part of a larger $17.5 million investment to help address the opioid crisis. The $10 million Iowa Opioid Treatment and Recovery Infrastructure Grant will assist opioid treatment and recovery providers with physical infrastructure and capacity building. The Iowa Recovery Housing Fund includes $3 million for grants for nonprofit organizations to develop sober recovery housing. The grants leverage federal American Rescue Plan Act funds. An additional $1.5 million will be used for programs focused on prevention, including a $1 million education initiative for health care providers to support opioid-alternative pain management and $500,000 for a comprehensive multimedia opioid overdose prevention campaign. The remaining $3 million will support the completion of a residential addiction treatment center for adolescents.

 

LAPPA releases model state laws to minimize harms of incarceration

The Legislative Analysis and Public Policy Association released two pieces of model state legislation. The first would require a state department of health and human services to apply for a Medicaid Reentry Section 1115 demonstration waiver to allow a state Medicaid program to cover pre-release services for Medicaid-eligible incarcerated individuals for up to 90 days prior to release and to require the department to conduct comprehensive monitoring and evaluation of the demonstration if the waiver is approved. The second is focused on reducing collateral consequences of conviction. It would establish a process for the identification, collection and publication of collateral consequences that impact individuals convicted of crimes; establish a process by which an individual can obtain a certificate of relief from certain collateral consequences before records are eligible to be sealed or expunged; establish mechanisms for the automatic sealing and expungement, as well as a process for petitioning; prohibit certain entities from inquiring into an individual’s criminal history; etc.

 

Other news in addiction policy

 

Mobile treatment vans can help expand methadone access

Some public health experts hope that mobile treatment programs will help increase access to methadone. Addiction experts say methadone is particularly important as the strength of street fentanyl has lessened the effectiveness of other medications and approaches for some. The mobile vans were approved by the federal government in 2021, lifting a moratorium on their use that had been in place since 2007. Their goal is to reach some of the millions of Americans with opioid use disorder that methadone clinics cannot. While the vans make treatment more accessible, the cost and ongoing restrictions limit the number of people that they can help, as well. Constructing and outfitting a methadone van costs about $375,000. They have to replicate the high-security environments of clinics, with a security guard, 360-degree cameras and a safe for the medication. There are now 42 vans registered nationally, though not all are operational yet.

 

Source: https://drugfree.org/drug-and-alcohol-news/policy-news-roundup-july-25-2024/

Biden’s drug czar is in West Virginia this week.

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

The number of drug overdoses in this country went down in 2023. But not enough.

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

July 29, 2024

This blog was also published in the American Society of Addiction Medicine (ASAM) Weekly on July 24, 2024.

Over the past several years, the increasing prevalence of fentanyl in the drug supply has created an unprecedented overdose death rate and other devastating consequences. People with an opioid use disorder (OUD) urgently need treatment not just to protect them from overdosing but also to help them achieve recovery, but highly effective medications like buprenorphine and methadone remain underused. Amid this crisis, it is critical that methadone, in particular, be made more accessible, as it may hold unique clinical advantages in the age of fentanyl.

Growing evidence suggests that methadone is as safe and effective as buprenorphine for patients who use fentanyl. In a 2020 naturalistic follow-up study, 53% of patients admitted to methadone treatment who tested positive for fentanyl at intake were still in treatment a year later, compared to 47% for patients who tested negative. Almost all (99%) of those retained in treatment achieved remission. An earlier study similarly found that 89% of patients who tested positive for fentanyl at methadone treatment intake and who remained in treatment at 6 months achieved abstinence.

Methadone may even be preferable for patients considered to be at high risk for leaving OUD treatment and overdosing on fentanyl. Comparative effectiveness evidence is emerging which shows that people with OUD in British Columbia given buprenorphine/naloxone when initiating treatment were 60% more likely to discontinue treatment than those who received methadone (1). More research is needed on optimal methadone dosing in patients with high opioid tolerance due to use of fentanyl, as well as on induction protocols for these patients. It is possible that escalation to a therapeutic dose may need to be more rapid.

It remains the case that only a fraction of people who could benefit from medication treatment for OUD (MOUD) receive it, due to a combination of structural and attitudinal barriers. A study using data from the National Survey on Drug Use and Health (NSDUH) from 2019—that is, pre-pandemic—found that only slightly more than a quarter (27.8%) of people who needed OUD treatment in the past year had received medication to treat their disorder. But a year into the pandemic, in 2021, the proportion had dropped to just 1 in 5.

Efforts have been made to expand access to MOUD. For instance, in 2021, the U.S. Department of Health and Human Services (HHS) advanced the most comprehensive Overdose Prevention Strategy to date. Under this strategy, in 2023, HHS eliminated the X-waiver requirement for buprenorphine. But in the fentanyl era, expanded access to methadone too is essential, although there are even greater attitudinal and structural barriers to overcome with this medication. People in methadone treatment, who must regularly visit an opioid treatment program (OTP), face stigma from their community and from providers. People in rural areas may have difficulty accessing or sticking with methadone treatment if they live far from an OTP.

SAMHSA’s changes to 42 CFR Part 8 (“Medications for the Treatment of Opioid Use Disorder”) on January 30, 2024 were another positive step taken under the HHS Overdose Prevention Strategy. The new rule makes permanent the increased take-home doses of methadone established in March 2020 during the COVID pandemic, along with other provisions aimed to broaden access like the ability to initiate methadone treatment via telehealth. Studies show that telehealth is associated with increased likelihood of receiving MOUD and that take-home doses increase treatment retention.

Those changes that were implemented during the COVID pandemic have not been associated with adverse outcomes. An analysis of CDC overdose death data from January 2019 to August 2021 found that the percentage of overdose deaths involving methadone relative to all drug overdose deaths declined from 4.5% to 3.2% in that period. Expanded methadone access also was not associated with significant changes in urine drug test results, emergency department visits, or increases in overdose deaths involving methadone. An analysis of reports to poison control centres found a small increase in intentional methadone exposures in the year following the loosening of federal methadone regulations, but no significant increases in exposure severity, hospitalizations, or deaths.

Patients themselves reported significant benefits from increased take-home methadone and other COVID-19 protocols. Patients at one California OTP in a small qualitative study reported increased autonomy and treatment engagement. Patients at three rural OTPs in Oregon reported increased self-efficacy, strengthened recovery, and reduced interpersonal conflict.

The U.S. still restricts methadone prescribing and dispensing more than most other countries, but worries over methadone’s safety and concerns about diversion have made some physicians and policymakers hesitant about policy changes that would further lower the guardrails around this medication. Methadone treatment, whether for OUD or pain, is not without risks. Some studies have found elevated rates of overdose during the induction and stabilization phase of maintenance treatment, potentially due to starting at too high a dose, escalating too rapidly, or drug interactions.

Although greatly increased prescribing of methadone to treat pain two decades ago was associated with diversion and a rise in methadone overdoses, overdoses declined after 2006, along with methadone’s use as an analgesic, even as its use for OUD increased. Most methadone overdoses are associated with diversion and, less often, prescription for chronic pain; currently, 70 percent of methadone overdoses involve other opioids (like fentanyl) or benzodiazepines.

Recent trials of models of methadone dispensing in pharmacies and models of care based in other settings than OTPs have not supported concerns that making methadone more widely available will lead to harms like overdose. In two feasibility studies, stably maintained patients from OTPs in Baltimore, Maryland and Raleigh, North Carolina who received their methadone from a local pharmacy found this model to be highly satisfactory, with no positive urine screens, adverse events, or safety issues. An older pilot study in New Mexico found that prescribing methadone in a doctor’s office and dispensing in a community pharmacy, as well as methadone treatment delivered by social workers, produced better outcomes than standard care in an OTP for a sample of stably maintained female methadone patients.

Critics of expanded access to methadone outside OTPs sometimes argue that the medication should not be offered without accompanying behavioural treatment. Data suggest that counselling is not essential. In wait-list studies, methadone treatment was effective at reducing opioid use on its own, and patients stayed in treatment. However, counselling may have benefits or even be indispensable for some patients to help them improve their psychosocial functioning and reduce other drug use. How to personalize the intensity and the level of support needed is a question that requires further investigation.

Over the past two decades, the opioid crisis has accelerated the integration of addiction care in the U.S. with mainstream medicine. Yet methadone, the oldest and still one of the most effective medications in our OUD treatment toolkit, remains siloed. In the current era of powerful synthetic opioids like fentanyl dominating the statistics on drug addiction and overdose, it is time to make this effective medication more accessible to all who could benefit. The recent rules making permanent the COVID-19 provisions are an essential step in the right direction, but it will be critical to pursue other ways that methadone can safely be made more available to a wider range of patients with OUD. Although more research would be of value, the initial evidence suggests that providing methadone outside of OTPs is feasible, acceptable, and leads to good outcomes.

Source: https://nida.nih.gov/about-nida/noras-blog/2024/07/to-address-the-fentanyl-crisis-greater-access-to-methadone-is-needed

Cannabis or more commonly known as marijuana, is one of the most frequently used drugs in the United States. In 2022, marijuana became more popular than alcohol as the preferred daily drug of use among Americans. In the same year, it was found that 30 out of every 100 high school age students reported using the drug within the past 12 months, and 3 of every 50 reported using it daily.

Marijuana is often perceived as harmless, which has influenced its increased use by a factor of 15 within the past three decades, but this substance can have severe physical and mental health effects.

This blog will share the heart-wrenching stories of Brant Clark and Shane Robinson, as told by their families, along with a recent article by Alton Northup editor-in-chief of KentWired. Their lives were tragically cut short by marijuana induced psychosis.

Brant Clark

Ann Clark shares the heartbreaking story of her 17-year-old son, Brant, who experienced cannabis-induced psychosis leading to his tragic suicide. She recounts his rapid descent into hopelessness and the devastating impact on their family to raise awareness about the dangers of marijuana use on mental health.

Ann Clark shares the heartbreaking story of her 17-year-old son, Brant, who experienced cannabis-induced psychosis leading to his tragic suicide. She recounts his rapid descent into hopelessness and the devastating impact on their family to raise awareness about the dangers of marijuana use on mental health.

Brant Clark (pictured) was a happy and bright 17-year-old who reported using marijuana socially. However, during his last high school winter break, after smoking marijuana at a party with friends, he experienced a psychotic break believed to have been triggered by smoking a large amount of potent marijuana.

After the party Brent expressed to his mother his feelings of “emptiness and hopelessness”, and deep regret, lamenting his decision to smoke marijuana. Within two days of the onset of symptoms, Brant was admitted to the ER and psychiatric care unit. Tragically, three weeks later, he ended his own life, leaving behind a note revealing his intense mental anguish and regret.

Brant’s doctor diagnosed him with Cannabis-Induced Psychosis, a condition where marijuana use leads to severe mental disturbances. Brant’s case highlights how this condition can manifest suddenly and with tragic consequences. Ann, Brant’s mother, recalls the happiness her son brought to her life, and the pain that lingers after his loss.

 Shane Robinson

In 2009, Lori Robinson’s son faced a similar fate. Shane, a vibrant 23-year-old, turned to marijuana for pain relief after a knee injury. Despite his parents’ concerns, Shane believed that the drug was a safe alternative to pain medication. However, Shane’s behavior changed drastically. He began to experience hallucinations and delusions. After being hospitalized several times and a prolonged struggle with mental health, Shane took his own life at the age of 25.

Lori, Shane’s mother, shared that the psychologists who treated her son questioned marijuana’s role in Shane’s mental illness, but neither Shane nor Brant had any prior history of mental illness, and their symptoms rapidly emerged after using marijuana.

Cannabis-Induced Psychosis would finally be added as a recognized mental health diagnosis in the year of 2013.

 

Medical and Scientific Insights

Although research still has a long way to go and should continue to examine how mental health disorders are affected by marijuana use independently, it should also focus on understanding the physiological mechanisms, as well as the effects of increased potency and contaminants in marijuana. The progress that has been made is enough to encourage the continuation of this field of research. Recent studies have shown strong associations between cannabis use disorder (CUD) and psychotic episodes. One study showed that 5 out of every 6 teenagers who sought help for a psychotic episode had used marijuana and that they were 11 times more likely to experience psychotic episodes compared to non-users of the drug. Another study showed a 30% increase in schizophrenia cases among men aged 21-30 were associated with CUD.

Dr. David Streem from the Cleveland Clinic shared with the editor of KentWired that he has observed a dramatic increase in psychosis cases over the past decade, which aligns with the increase in marijuana potency from less than 10% in the 90s to 30% or more today.

Advocating for Prevention

Ann Clark and Lori Robinson have become advocates, raising awareness about the dangers of cannabis-induced psychosis. Despite facing skepticism and opposition, they courageously continue to share their son’s stories to educate others about the potential risks of marijuana use.

As marijuana becomes widely legalized, Ann believes that “it only gives our young people a lower perception of harm, and a false sense of security and safety”. However, increased levels of THC and the building body of evidence linking marijuana to mental health conditions, call for greater public health education and regulations.

The tragic stories of Brant and Shane underscore the urgent need for awareness about cannabis-induced psychosis as the use of marijuana becomes more prevalent among younger populations.

Source: https://kentwired.com/120770/news/cannabis-induced-psychosis-cost-their-sons-their-lives-more-could-be-next/

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.

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

Press Release: Ambassador Linda Thomas-Greenfield Launches Alliance to Prevent Drug Harms in Collaboration with United Nations and Tech Industry

Today, Ambassador Linda Thomas-Greenfield, Representative of the United States to the United Nations, launched the Alliance to Prevent Drug Harms (Prevent Alliance), alongside representatives from the United Nations and the tech industry, including Meta, Snap Inc., and X Corp.

“Two out of every five Americans know someone who has died of an opioid overdose…in every corner of the world…we’re seeing a rapid rise in synthetic drug use, dependence, and overdose death,” said the Ambassador. “This is an international crisis…we’ve seen the criminal groups that produce these drugs adapt quickly.”

That adaptation includes the use of technology platforms, including social media, to promote the illicit use of non-medical synthetic drugs.

“This alliance between the United States, the United Nations, and our partners in the private sector, holds immense potential to make a meaningful difference. To disrupt this crisis, both here in the United States and all across the globe, and adapt with the same agility, the same resourcefulness, of those we’re up against. This is a good step, but we all know much more needs to be done to address this problem.” Ambassador Thomas-Greenfield continued.

The Prevent Alliance, a public-private partnership effort, is committed to ending the use of online platforms to aid the flow of illicit substances. Through a framework for cross-industry cooperation, the Prevent Alliance will work to disrupt the availability of synthetic drugs online, promote drug-prevention content across platforms, and enables cross-sector communication establishing the best evidence-based practices for drug-prevention campaigns.

The alliance builds upon the work of the Global Coalition to Address Synthetic Drug Threats, a multilateral effort to combat the threats posed by synthetic drugs launched by Secretary Blinken last year, and the U.S.-led adoption of new controls targeting the synthetic drug manufacturing process at the UN Commission on Narcotic Drugs earlier this year.

Maggie Nardi, the Deputy Assistant Secretary of State of the Bureau for International Narcotics and Law Enforcement Affairs (INL), said, “Governments alone cannot shield people from the dangers of synthetic drug misuse; we must forge stronger alliances with public health, civil society, affected communities, academics, and industry to combat their illicit manufacture, distribution, and promotion.”

Under the Biden Administration, the United States is dedicating more resources to tackle the demand for drugs, including more resources for public awareness, health interventions and services to prevent and reduce the implications of drug use, as well as measures to prevent, detect, and stop the illicit manufacturing and trafficking of drugs. These efforts include support for the UN Office on Drugs and Crime (UNODC) and Commission on Narcotic Drugs, as well as U.S. leadership in rallying countries around the Global Coalition to Address Synthetic Drug Threats.

“Evidence-based prevention is key to respond to the drug use situation globally, especially in a rapidly digitalized world. Social media nowadays carries an important influence on the individual. To harness this influence positively, science can help,” said Delphine Schantz, director of UNODC’s New York office. “UNODC together with WHO reflected on that science through the International Standards on Drug Use Prevention. This science aims at creating a healthy and safe environment for children and youth, fostering resilient generations against drugs and any risky social and health behaviors. Working through this science, social media could be one of those added layers of prevention.”

“Families and communities around the world are struggling with the opioid crisis,” said Nell McCarthy, Vice President of Trust and Safety at Meta. “From governments to the private sector, and health care systems to civil society organizations, we must all do our part to combat this crisis, which is why Meta is proud to be part of the Prevent Alliance.”

Source: https://usun.usmission.gov/ambassador-linda-thomas-greenfield-launches-alliance-to-prevent-drug-harms-in-collaboration-with-united-nations-and-tech-industry/ July 2024

More than 178 000 people died from excessive alcohol use in the US during 2020 to 2021, surpassing deaths from the overdose epidemic.1 Excessive drinking is now the leading cause of preventable death in the US.1 Alcohol use disorder (AUD) most commonly begins during adolescence, although rarely is it identified and treated at this age.2 We urgently need interventions that allow us to better identify those young people at risk of developing AUD and alcohol-related complications later in adulthood. In their study of alcohol use among youths with a chronic medical condition (CMC), Weitzman et al3 describe a novel approach for alcohol prevention in a population of youths with medical vulnerability. Youths with a CMC are particularly susceptible to the effects of alcohol and warrant particular attention. Although the rate of alcohol use among these youths is similar to that of their peers, youths with a CMC have higher rates of progression to heavy alcohol use and AUD.4 Weitzman et al3 found that high-risk alcohol use occurred in more than 1 of 10 youths (aged 14-18 years) with a CMC seen in the specialty clinics included in their study. These youths also have an increased risk of treatment nonadherence and potential medication reactions with alcohol as a result of the underlying disease, worsening the potential effects of high-risk alcohol exposure in this population.4

Given these disparities, Weitzman et al3 designed a randomized clinical trial aimed at evaluating the effects of the Take Good Care (TGC) alcohol use prevention intervention over 12 months among youths with a CMC. In the specialty clinic setting, youths in the intervention group received a brief, personalized intervention consisting of a self-administered slide deck on an electronic tablet. Slides were disease tailored, and they included specific effects of alcohol use on disease processes, treatment safety, and efficacy as well as motivational information on health-protecting decisions and behaviors. Although there was no change among youths reporting no or minimal (low-risk) alcohol use, there was a 40% relative reduction in self-reported frequency of alcohol use among those receiving the TGC intervention who reported high-risk alcohol use at baseline compared with those who received treatment as usual.

The study by Weitzman et al3 highlights the potential importance of brief interventions in changing youth behavior, particularly among a group of youths who are medically vulnerable. Although a shocking 11.5% of youths with a CMC in this study reported high-risk alcohol use at baseline, nationally only a quarter of pediatricians report using validated screening tools to assess alcohol use among adolescents and only 11% of pediatricians correctly use the Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool recommended by the American Academy of Pediatrics.5 Despite growing evidence supporting the benefit of SBIRT for pediatric populations, barriers to implementation include insufficient time and need for clinician training5; both of these barriers are ameliorated with the use of the self-administered, electronic intervention described by Weitzman et al.3 This study adds to the growing database highlighting the effectiveness of SBIRT in identifying and intervening in instances of substance use among youths. It presents a tool easily adopted by clinicians, with an impact on those youths at greatest risk of developing problematic alcohol use.

Considering the prevalence of alcohol use among youths with CMCs, an important aspect of the study by Weitzman et al3 is its low-touch intervention that can be easily adapted and implemented in a variety of clinical settings. Weitzman et al3 show the value of even simple, low-touch interventions in changing youth behavior. From the patient perspective, the use of an electronic tablet enhances privacy when answering questions and allows for flexibility in time spent on each piece of content. From the clinician perspective, the use of an electronic tablet requires minimal additional effort or training, standardizes the content provided, and allows for intervention completion outside of face-to-face appointment time. Yet despite its simplicity, the low-touch TGC intervention has been shown to exert a substantial effect on adolescent behavior. At 12 months, the reduction in alcohol use frequency among youths with a CMC and high-risk alcohol use represents not only a meaningful behavioral change but also an enduring one.

In contrast with traditional fear-based messages around alcohol prevention, Weitzman et al3 demonstrate the impact of a strengths-based model that engages the normal adolescent quest for independence and the examination of choice in larger contexts. The TGC intervention educated youths with a CMC on disease-specific processes, treatments, and effects of alcohol, thereby encouraging reflection around alcohol-related choices. In presenting this information for youths to consider, the intervention relayed respect for patients’ ability to engage in their own health care and health behaviors. Additionally, disease-tailored content paired with motivational information on health-protecting behaviors encouraged patients’ sense of autonomy and independence. The statistically significant effects of this approach suggest that personalized intervention resonates with youths with CMCs and is an effective tool for behavioral change. Furthermore, this delivery model allows for content to be tailored based on disease or other aspects of youths’ lived experience. Content adjusted to the needs of specific subpopulations of youths creates interventions that they connect with and are thus most greatly affected by, in both depth and longevity of impact.

Finally, key to the study by Weitzman et al3 is the intervention location; utilization of the specialty care setting for an alcohol use prevention intervention is novel and effective. Many youths with a CMC receive the majority of their care in the specialty care setting and, accordingly, often develop stronger therapeutic relationships with their specialty care physician than their primary care physician. In 41.3% of visits to their specialists, youths with a CMC present for routine preventative care,6 yet specialists screen for substance use at alarmingly low rates compared with their primary care counterparts (self-reported 8% vs 38%, respectively).7 Interventions within the specialty clinic space allow for greater potential to reach more youths with CMCs at critical moments in their health journeys, thereby curbing heavy alcohol use, its associated medication nonadherence, and potential interaction with medications. By doing so, this method of intervention may decrease disease-associated complications and mortality in addition to alcohol-associated complications and mortality among youths with CMCs, and by extension, the adults that they become. The TGC intervention and its broader application represent an exciting new paradigm for future practice.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820973 July 2024

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

By: Imtiyaz Maqbool Banday @ KI News

As we continue to grapple with the scourge of drug abuse, it’s essential to reexamine our approach to prevention and treatment. While raising awareness about the dangers of drugs is crucial, we must also consider if our efforts are inadvertently glamorizing drug use. Islam teaches us to avoid excess and extravagance (Israaf) and seek refuge in Allah from harmful substances (Khabeeth).

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.

A New Approach: 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.

Conclusion

Let us work together to create a society that values recovery, support, and Islamic principles, rather than perpetuating the cycle of drug abuse. We must avoid glamorizing drug use, promote a culture of recovery and support, encourage seeking help and guidance, foster gratitude for health and well-being, and support individuals in their struggles and recovery. By adopting a more balanced approach, we can create a brighter future for all, free from the shackles of drug abuse.

Kashmir Images is an English language daily newspaper published from Srinagar (J&K), India. The newspaper is one of the largest circulated English dailies of Kashmir and its hard copies reach every nook and corner of Kashmir Valley besides Jammu and Ladakh region.

Source: https://thekashmirimages.com/2024/07/04/rethinking-our-approach-to-drug-abuse-prevention-an-islamic-perspective/

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/

 

360info: 05/07/2024 23:30 MYT

Countries are looking at evidence-based alternatives, with a shift towards public health strategies, to fight the drug scourge – Michael Joiner/360info
THE UN’s annual World Drug Report warns of a rise in drug use and trafficking globally.
The report, released in conjunction with the International Day against Drug Abuse and Illicit Trafficking, or World Drug Day on June 26, found the number of drug users reached 292 million in 2022, with cannabis being the most common drug used.
However, the emergence of new synthetic opioids such as nitazenes is causing concern due to their potency and potential for overdose deaths.
The report also highlighted how drug cartels in Southeast Asia are weaving themselves into a web of illegal activities, including wildlife trafficking and deforestation. This devastates the environment and displaces communities. Increased cocaine production fuels violence along transportation routes, while high-THC cannabis legalisation in some countries is associated with a rise in attempted suicides.
The traditional criminal justice approach, prioritising arrests and punishment, is proving ineffective. Countries are looking at evidence-based alternatives, with a shift towards public health strategies.
This week, Malaysia tabled new amendments to the Drug Dependants (Treatment and Rehabilitation) Act 1983 which would empower officers from the country’s drug agency to arrest, treat, and rehabilitate “drug dependants or misusers” in a bid to ease overcrowding in prisons.
The bill is seen as a step away from the country’s draconian anti-drug laws, shifting the focus from locking up people who use drugs to treatment and rehabilitation. But experts are worried about making rehabilitation mandatory for all and whether the current rehabilitation centres are well equipped to accommodate the influx of patients.
Australia offers a fascinating case study on the complexities of drug policy reform. While the government allocates significant resources to law enforcement, harm reduction and prevention programmes receive a fraction of the funding. This imbalance raises questions about the effectiveness of the current approach.
Pill testing will be introduced in the state of Victoria later in the year, aimed at reducing the risk of overdose deaths, especially at music festivals. It follows similar schemes in the Australian Capital Territory and Queensland which have so far shown to save lives. This has encouraged the state of New South Wales to implement a similar approach.
Australia has also taken a progressive step by making naloxone, a life-saving medication that reverses opioid overdoses, free and available without a prescription, although uptake has been slow.
The illegal drug trade poses a significant threat to national security in some countries. India’s northeast states, bordering Myanmar, serve as a stark example. The drug trade fuels violence and instability, highlighting the need for a comprehensive approach that addresses security concerns and public health.
The situation in Punjab also struggles with widespread substance use and trafficking. Addressing the underlying factors that contribute to drug use, such as lack of economic opportunities, is crucial to tackling this issue effectively.
This year’s World Drug Day theme acknowledges that it is crucial to adopt a scientific evidence-based approach that prioritises prevention and treatment as a step for drug policy reform.
A public health approach that prioritises harm reduction, treatment, prevention, and dismantling accessibility barriers offers a more promising path forward, promoting public health and safety while fostering global stability.

By Shahirah Hamid: Senior Commissioning Editor at 360info Southeast Asia

Source: https://www.astroawani.com/berita-dunia/rethinking-drug-policy-punishment-public-health-477633

International Day against Drug Abuse and Illicit Trafficking on June 26:

June 23, 2024 1:05 am

By Resolution 42/112 of 7 December 1987, the General Assembly decided to observe June 26 as the International Day against Drug Abuse and Illicit Trafficking as an expression of its determination to strengthen action and cooperation to achieve the goal of an international society free of drug abuse. No country has been spared of the drug menace, though some countries have been disproportionately affected. While most countries nab and rehabilitate drug users, the big-time dealers and smugglers often go scot free, leading to a vicious cycle.

Supported each year by individuals, communities, and various organisations all over the world, this global observance aims to raise awareness of the major problem that illicit drugs represent to society.

Challenges

The global drug problem presents a multifaceted challenge that touches the lives of millions worldwide. From individuals struggling with substance use and associated disorders to communities grappling with the consequences of drug trafficking and organised crime, the impact of drugs is far-reaching and complex. Central to addressing this challenge is the imperative to adopt a scientific evidence-based approach that prioritises prevention and treatment.

The International Day against Drug Abuse and Illicit Trafficking, or World Drug Day, is marked to strengthen action and cooperation in achieving a world free of drug abuse. This year’s (2024) World Drug Day campaign recognises that effective drug policies must be rooted in science, research, respect for human rights, compassion, and a deep understanding of the social, economic, and health implications of drug use.

Together, all should be determined to combat the global drug problem, guided by the principles of science, compassion, and solidarity.

Continued record illicit drug supply and increasingly agile trafficking networks are compounding intersecting global crises and challenging health services and law enforcement responses, according to the World Drug Report 2023 launched by the UN Office on Drugs and Crime (UNODC). This year’s report will be launched next week.

New data put the global estimate of people who inject drugs in 2021 at 13.2 million, 18 percent higher than previously estimated. Globally, over 296 million people used drugs in 2021, an increase of 23 percent over the previous decade. The number of people who suffer from drug use disorders, meanwhile, has skyrocketed to 39.5 million, a 45 percent increase over 10 years.

Latest findings

The World Drug Report also highlights how social and economic inequalities drive – and are driven by – drug challenges; the environmental devastation and human rights abuses caused by illicit drug economies; and the rising dominance of synthetic drugs.

The demand for treating drug-related disorders, including mental conditions, remains largely unmet, according to the report. Only one in five people suffering from drug-related disorders was in treatment for drug use in 2021, with widening disparities in access to treatment across regions and countries.

Youth are the most vulnerable to using (or rather abusing) drugs and are also more severely affected by substance use disorder in several regions. In Africa, 70 percent of people in treatment are under the age of 35.

Public health, prevention, and access to treatment services must be prioritised worldwide, the report argues, or drug challenges will leave more people behind.

The report underscores the need for law enforcement responses to keep pace with agile criminal business models and the proliferation of cheap synthetic drugs that are easy to bring to market. Criminals producing methamphetamine – the world’s dominant illegally manufactured synthetic drug – evade law enforcement and regulatory responses through new synthesis routes, bases of operation, and non-controlled precursors.

Fentanyl has drastically altered the opioid market in North America with dire consequences. In 2021, the majority of the approximately 90,000 opioid related overdose deaths in North America involved illegally manufactured fentanyls.

Local situation

In Sri Lanka, the single most significant drug problem is the trafficking of heroin for local consumption. Sri Lanka serves as a transshipment hub for heroin trafficked into the country mainly from South Asian and West Asian locations. It is estimated that there are about 45,000 regular users of heroin and about 600,000 users of cannabis in the country. The recent Yukthiya operation netted a large number of addicts and pushers. Moreover, several drug lords who were hiding abroad have been brought down and produced before courts.

In fact, the nexus between organised crime and drug trafficking is rather well-known. Central and South American drug cartels are best known for extreme violence. In Sri Lanka too, most of the motorcycle killings (turf wars) have been attributed to rivalry between different drug dealing gangs. Underworld factions, sometimes, led by leaders living in exile in the Middle East, depend mainly on the drug business for their survival. Even prison and law enforcement officers have been caught dealing with or assisting notorious drug barons who are behind bars.

It is vital to nab the “big fish” who control the flow of drugs into the country and their distribution within the country. All drug addicts must be rehabilitated, instead of being sent to prison. This, after all, is one reason for the overcrowding of prisons. Another factor is that otherwise innocent drug users come into contact with hardened criminals inside the prison and could take to crime.

Our Security Forces must be equipped with the latest surveillance devices including long range drones to detect any incoming vessels smuggling drugs. This is important because the Navy and the Coastguard cannot cover the entire Exclusive Economic Zone. However, even amidst equipment and manpower issues, the Sri Lanka Navy has been successful in busting several drug smuggling rings that operate in and around Sri Lanka.

Enforcing the law against drug trafficking is important, but in keeping with this year’s World Drug Day theme, prevention is even more essential. This should begin from home or school, with students being warned on the dangers posed by illicit drugs of all types (this does not mean that legally available drugs such as tobacco are any better). Even some legal OTC pharmaceuticals can be abused if taken in abnormal quantities.

Drug trafficking is a complex global problem that demands global solutions with the active participation of all countries. That is essential to save the future generations from this scourge.

Source: https://www.sundayobserver.lk/2024/06/23/impact/25805/focus-on-preventing-drug-abuse/

 By KEVIN A. SABET, PH.D., President of the Foundation for Drug Policy Solutions

June 25, 2024

From Oregon to Canada to Thailand, policymakers and the public alike are waking up to the consequences of lenient and irresponsible drug policies. Whether it is the commercialization of marijuana or the decriminalization of all other drugs, policymakers are learning the hard way that public health and safety must remain a jurisdiction’s priority. As we approach the International Day Against Drug Abuse and Illicit Trafficking, on June 26, policymakers elsewhere should learn from these lessons and avoid making these same mistakes.

 

Just over a year ago, British Columbia received an exemption from Canada’s Controlled Drugs and Substances Act, allowing the province to decriminalize the public use of dangerous illicit drugs, including fentanyl, methamphetamine, heroin, and cocaine. The public policy was viewed as a triumph by so-called “harm reduction” activists, who push dangerous perceptions that drug use should be normalized and condoned.

 

Parents were understandably outraged to witness people using drugs in a host of public spaces, including parks where their young children were playing. In short order, British Columbia saw a record 2,511 overdose deaths last year and the Deputy Chief of the Vancouver Police Department warned “there have been concerns from small businesses about problematic drug use,” among other consequences.  In turn, public pushback, alongside the pressure of an upcoming election, compelled policymakers to respond and reverse course.

 

Though this sounds like a common-sense move, officials in Canada have been misled into believing that mass decriminalization of drugs would somehow improve public health. The addiction-for-profit industry has fueled this belief via a massive misinformation campaign about the harms of marijuana and other drugs. Elected officials in BC were reminded about the importance of protecting the interests of non-users and the broader community.

 

Officials in Oregon, United States, recently learned a similar lesson, backtracking their experiment with the decriminalization of all illicit drugs. Passed under the guise of an activist-driven ballot measure in 2020, Oregon took a hands-off approach to its drugcrisis, allowing people to do as they pleased with drugs. Like in British Columbia, public drug use skyrocketed. Perhaps unsurprisingly, the number of overdose deaths increased, as did the prevalence of substance use and crime.

 

In April, acknowledging that this policy had not gone as promised, liberal Governor Tina Kotek signed legislation to repeal Measure 110 and recriminalize drug possession, despite promising to uphold Measure 110 just months before. In its place is a framework to increase access to treatment. Elected officials in Oregon were reminded about the importance of treatment.

 

Thailand, the first and only country in Asia to legalize recreational marijuana, is now backtracking and aims to ban recreational marijuana by the end of the year. Reuters reported, “tens of thousands of cannabis shops have sprung up.” Likewise, the illicit market has expanded, and numerous illicit marijuana shops have emerged throughout communities. And psychosis related to marijuana has doubled to more than 20,000 cases since legalization.

 

Officials in Thailand were alarmed to find the marijuana industry aggressively marketing its products, prioritizing its profits ahead of public health. The industry’s predatory practices have led to higher rates of marijuana use among minors. Elected officials in Thailand were reminded about how the interests of the profit-driven marijuana industry are at odds with public health and safety.

 

Policymakers elsewhere should learn from the unintended consequences of these experiments to implement better, safer drugpolicies. It should not be controversial to prohibit public drug use or to implement policies that guide people into treatment. It should not be controversial to say we distrust the motives of emerging addiction-for-profit industries. Countries continue to contemplate extreme policy measures like drug legalization and decriminalization, they would do well to heed the lessons learned by Thailand, British Columbia, Oregon, and more.

 

International Day Against Drug Abuse and Illicit Trafficking is also a fitting time to recognize the importance of supply reduction. Law enforcement agencies in the US and around the world should be commended for standing up to the cartels and their affiliates, and they should be further empowered to crack down on those trafficking dangerous psychoactive drugs.

 

We must recommit ourselves to implementing evidence-based drug policies focused on prevention, treatment, harm reduction, and recovery, as well as supply reduction. Doing so would help elected officials remember the importance of public health and oppose the for-profit interests of emerging industries. Oregon, British Columbia, and Thailand are reminders of what happens when these common-sense messages are forgotten or ignored.

Kevin A. Sabet, Ph.D. is  a former drug policy advisor to U.S. Presidents Obama, Bush and Clinton. 

 

Source: https://gooddrugpolicy.org/

Simantik Dowerah – First Post India June 26, 2024

Social stigma and low awareness about available treatment options significantly impact treatment-seeking behaviours, professor at the Department of Psychiatry at NIMHANS Bangalore, Dr Prabhat Chand tells Firstpost
(File) Students take part in an awareness march to mark the International Day against Drug Abuse and Illicit Trafficking, in Patna. PTI

The International Day Against Drug Abuse and Illicit Trafficking, observed every year on 26 June, serves as a global reminder of the urgent need to combat the menace of drug abuse and illicit trafficking. This day aims to raise awareness about the severe impact of drug addiction on individuals, families and communities worldwide. It also emphasises the importance of prevention, treatment and rehabilitation efforts to address this complex issue.

Governments, organisations and individuals come together on this day to advocate for policies and actions that promote a drug-free world, supporting those affected by addiction and working towards sustainable development and peace. The day calls for solidarity and collective action to safeguard public health and build healthier, safer societies for all.

On the occasion of the International Day Against Drug Abuse and Illicit Trafficking, Firstpost interviewed Dr Prabhat Chand, professor at the Department of Psychiatry, Centre for Addiction Medicine & NIMHANS Digital Academy VKN ECHO, Bangalore to gain insights into drug abuse trends in India and its broader societal implications.

How grave is drug abuse in India and how have their usage patterns changed over time?

Drug abuse in India is a significant public health challenge affecting diverse populations across the nation. The most abused substances after alcohol are cannabis and opioids. According to national surveys, the prevalence of cannabis users is 3.1 crore and about 72 Lakh are problem users. The opioid use increased significantly from 0.7 per cent to 2.1 per cent (i.e., 2.3 crore) during the same period. Other substances such as sedatives (1.08 per cent), inhalants (0.7 per cent), cocaine (0.10 per cent), amphetamines (0.18 per cent), and hallucinogens (0.12 per cent) also contribute significantly to the drug abuse landscape. The International Day Against Drug Abuse and Illicit Trafficking on June 26th, 2024, with the theme ‘The evidence is clear: invest in prevention,’ underscores the urgency of this issue.

How do socio-economic factors influence vulnerability to substance abuse in India? What are the demographics mostly affected and at high risk?

Socio-economic factors such as peer influence, societal pressures, difficult childhood and lack of access to supportive environments significantly influence vulnerability to substance abuse in India. The demographics mostly affected and at high risk include young male adults aged 18-25, people from low socio-economic backgrounds and those with lower educational attainment. Over the years, the age of onset for first substance use has been decreasing consistently.

What are the primary challenges in accessing addiction treatment facilities across different tiers of cities in India?

Access to treatment facilities varies significantly across different regions and city tiers. The treatment gap for addictive disorders is as high as 75 per cent, as per various national surveys. It means 75 out of 100 people with addictive disorders do not have access to care. The challenge is twofold – 1. Accessibility of care 2. Quality of care. For example, for opioid use disorder, Opioid against treatment (OAT) is evidence-based care across the world. But in India, the supply of OAT is available in very few places. That means people have to travel far to access the care. It is well known that addiction is a chronic brain condition and needs good aftercare. These are compounded by strong social stigma and low awareness. This emphasises the need for significant investments to enhance treatment options and optimise resource allocation based on national survey evidence.

How does stigma impact treatment-seeking behaviours in rural areas compared to urban centres?

Social stigma and low awareness about available treatment options significantly impact treatment-seeking behaviours. This leads people with addictive disorders to seek treatment at the later stage of the addiction cycle. Also, the studies show that more than 50 per cent of patients likely have comorbid psychiatric disorders, which also makes care more challenging. Bridging this gap requires tailored health service information campaigns to inform users and the general population about the available treatment services.

What strategies are recommended to bridge the treatment gaps between urban and rural areas, especially in smaller pockets and villages?

To bridge the treatment gaps – 1. Increase access to care 2. Making knowledge the effective interventions to the health care providers 3. Early identification by physicians, nurses or healthcare providers 4. Identification of high-risk youth and provider of holistic support 5. Integrate common substance use along with routine care like hypertension or diabetes.

Integrated care models and effective coordination between drug supply control and entities focused on demand reduction and harm reduction are crucial. Additionally, targeted outreach and education programmes can help prevent substance abuse and identify people in need of treatment at an earlier stage.

Why is it crucial to address gender disparities in treatment-seeking behaviours?

Addressing gender disparities in treatment-seeking behaviours is crucial because men predominantly access services compared to women. Tailored health service information campaigns are necessary to engage women and marginalised communities effectively, ensuring equitable access to treatment and support services. By promoting inclusivity in treatment access, India can foster a supportive societal framework that empowers people affected by substance abuse.

How can integrated care models improve outcomes for people with co-occurring substance abuse and mental health disorders?

Integrated care models can improve outcomes by providing comprehensive services that address both substance abuse and co-occurring mental health disorders. This necessitates significant investments to enhance treatment options and ensure effective coordination between drug supply control, demand reduction, and harm reduction entities. Such models are essential for addressing the multifaceted nature of substance abuse and its associated mental health issues.

What role do government policies, healthcare providers, NGOs and communities play in tackling the drug abuse crisis in India and how can collaboration be enhanced to achieve better outcomes?

Government policies, healthcare providers, NGOs and communities play a crucial role in tackling the drug abuse crisis in India. Collaboration among these entities can be enhanced by fostering coordination between drug supply control and demand reduction efforts, expanding treatment accessibility, promoting inclusivity in treatment access, and implementing targeted outreach and education programmes. By prioritising evidence-based strategies and fostering a supportive societal framework, India can empower people affected by substance abuse to reclaim their lives and contribute meaningfully to society. Sustained efforts in prevention, treatment infrastructure expansion and effective policy formulation are essential to achieving better outcomes and paving the way towards a healthier, drug-free future for Indian citizens.

Healthcare providers like doctors can use the ‘Addiction Rx mobile app’ as a guidance tool for screening, assessment and intervention in addictive disorders. This app is developed as a part of the standard treatment guidelines by the Ministry of Health and Family Welfare DDAP Addiction Rx app: iOS and Android.

The doctors, counsellors and nurses can discuss the cases and enrol in certificate courses at the NIMHANS Digital Academy ECHO weekly tele-platform to learn best practices.

Source: https://www.firstpost.com/india/international-day-against-drug-abuse-a-significant-public-health-challenge-affecting-india-13786238.html

Published: Jun 28, 2024, 7:02 PM

It seems as if every community, big or small, has been impacted by the problems associated with substance use and drug overdose. Within these communities, these problems extend into the family unit, with people 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.

Locally, the Kansas Prevention Collaborative partners with several different states and educational institutions and provides agencies. Substance misuse prevention focuses on underage drinking, marijuana use, and other substances.

Additionally, they offer the “It Matters” campaign, which focuses on the power of perception to help youth and young adults avoid substance misuse. The behavioral health services and programs in the state are provided by the Kansas Department for Aging and Disability Services, which includes treatment, recovery, and prevention.

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 experiment with illicit drugs that are potentially laced with opioids.

According to drug abuse statistics, an average of 156 people die from opioid overdose in one year in Kansas. Opioids are a factor in 45.2% of all overdose deaths in the state. The Kansas Department of Health and Environment reported the rate of drug overdose deaths in the state of Kansas almost tripled within the last year few years. Drug education and prevention can help.

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 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 non-profit 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.

Source: https://www.gbtribune.com/opinion/local-drug-education-and-prevention-programs-are-here-help/

26 June 2024

 

Drugs are at the root of immeasurable human suffering.

Drug use eats away at people’s health and wellbeing. Overdoses claim hundreds of thousands of lives every year.

Meanwhile, synthetic drugs are becoming more lethal and addictive, and the illicit drug market is breaking production records, feeding crime and violence in communities around the world.

At every turn, the most vulnerable people — including young people — suffer the worst effects of this crisis. People who use drugs and those living with substance abuse disorders are victimized again and again: by the drugs themselves, by stigma and discrimination, and by heavy-handed, inhumane responses to the problem.

As this year’s theme reminds us, breaking the cycle of suffering means starting at the beginning, before drugs take hold, by investing in prevention.

Evidence-based drug prevention programmes can protect people and communities alike, while taking a bite out of illicit economies that profit from human misery.

When I was Prime Minster of Portugal, we demonstrated the value of prevention in fighting this scourge. From rehabilitation and reintegration strategies, to public health education campaigns, to increasing investment in drug-prevention, treatment and harm-reduction measures, prevention pays off.

On this important day, let’s recommit to continuing our fight to end the plague of drug abuse and trafficking, once and for all.

 

Source: https://www.unodc.org/islamicrepublicofiran/en/the-secretary-general-message-on-the-occasion-of-the-international-day-against-drug-abuse-and-illicit-trafficking.html

COVID-19 pandemic and increasingly dangerous drug supply among factors that may have contributed to diminished impact of intervention

A data-driven intervention that engaged communities to rapidly deploy evidence-based practices to reduce opioid-related overdose deaths – such as increasing naloxone distribution and enhancing access to medication for opioid use disorder – did not result in a statistically significant reduction in opioid-related overdose death rates during the evaluation period, according to results from the National Institutes of Health’s HEALing (Helping to End Addiction Long-Term) Communities Study. Researchers identified the COVID-19 pandemic and increased prevalence of fentanyl in the illicit drug market – including in mixtures with cocaine and methamphetamine – as factors that likely weakened the impact of the intervention on reducing opioid-related overdose deaths.

The findings were published in the New England Journal of Medicine and presented at the College on Problems of Drug Dependence (CPDD) meeting on Sunday, June 16, 2024. Launched in 2019, the HEALing Communities Study is the largest addiction prevention and treatment implementation study ever conducted and took place in 67 communities in Kentucky, Massachusetts, New York, and Ohio – four states that have been hard hit by the opioid crisis.

Despite facing unforeseen challenges, the HEALing Communities Study successfully engaged communities to select and implement hundreds of evidence-based strategies over the course of the intervention, demonstrating how leveraging community partnerships and using data to inform public health decisions can effectively support the uptake of evidence-based strategies at the local level.

“This study brought researchers, providers, and communities together to break down barriers and promote the use of evidence-based strategies that we know are effective, including medications for opioid use disorder and naloxone,” said NIDA director, Nora D. Volkow, M.D. “Yet, particularly in the era of fentanyl and its increased mixture with psychostimulant drugs, it’s clear we need to continue developing new tools and approaches for addressing the overdose crisis. Ongoing analyses of the rich data from this study will be critical to guiding our efforts in the future.”

NIH launched the HEALing Communities Study, a four-year, multisite research study to test a set of evidence-based interventions for reducing overdose deaths across health care, justice, and behavioral health settings. Over 100,000 people are now dying annually of a drug overdose, with over 75% of those deaths involving an opioid. Numerous evidence-based practices have been proven to prevent or reverse opioid overdose, but these strategies are gravely underused due to a number of barriers.

As part of the intervention, researchers collaborated with community coalitions to implement evidence-based practices for reducing opioid overdose deaths from the Opioid-Overdose Reduction Continuum of Care Approach. These evidence-based practices focus on increasing opioid education and naloxone distribution, enhancing access to medication for opioid use disorder, and safer opioid prescribing and dispensing. The intervention also included a series of communication campaigns to help reduce stigma and increase the demand for evidence-based practices.

Communities were randomly assigned to either receive the intervention (between January 2020 and June 2022) or to the control group (which received the intervention between July 2022 and December 2023). To test the effectiveness of the intervention on reducing opioid-related overdose deaths, researchers compared the rate of overdose deaths between the communities that received the intervention immediately with those that did not during the period of July 2021 and June 2022.

Between January 2020 and June 2022, intervention communities successfully implemented 615 evidence-based practice strategies (254 related to overdose education and naloxone distribution, 256 related to medications for opioid use disorder, and 105 related to prescription opioid safety).

Despite the success in deploying evidence-based interventions in participating communities, between July 2021 and June 2022, there was not a statistically significant difference in the overall rate of opioid-involved overdose deaths between the communities receiving the intervention and those that did not, (47.2 opioid-related overdose deaths per 100,000 people in the intervention group, versus 51.7 in the control). The study team is also examining data on the impact of the intervention on total overdose deaths and examining specific drug combinations, such as stimulants and opioids, and on non-fatal opioid overdoses, among other study outcomes.

“The implementation of evidence-based interventions is critical to addressing the evolving overdose crisis,” said Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA. “This study recognizes there is no quick fix to reduce opioid overdose deaths. Saving lives requires ongoing commitment to evidence-based strategies. The HEALing Communities Study facilitated the implementation of 615 evidence-based practice strategies, with the potential to yield lifesaving results in coming years.”

The authors highlight three specific factors that likely weakened the impact of the intervention on reducing opioid-related overdose deaths. First, the intervention launched two months before the COVID-19 shutdown which severely disrupted the ability to work with health care, behavioral health, and criminal legal systems in implementing evidence-based practices. Indeed, due in large part to the emergence of the COVID-19, only 235 of the 615 strategies (38%) were implemented before the comparison period began in July 2021.

Second, after communities selected which evidence-based practices they wanted to implement, they only had 10 months to implement them before the comparison period began. The authors note that this was not enough time to robustly recruit necessary staff, change clinical practice workflows, or develop new collaborations across agencies and organizations. They note more time to implement these strategies, and more time between implementation and measuring results, may be needed to observe the full impact of the intervention.

Lastly, significant changes in the illicit drug market could have impacted the effectiveness of the intervention. Fentanyl increasingly permeated the illicit drug supply, and was increasingly mixed or used in combination with stimulant drugs like methamphetamine and cocaine, or in counterfeit pills made to look like prescription medications. The increasing use of fentanyl, as well as xylazine, over the study period posed new challenges for treatment of opioid use disorder and opioid-related overdose.

“Even in the face of a global pandemic and worsening overdose crisis, the HEALing Communities Study was able to support the implementation of hundreds of strategies that we know save lives,” said Redonna Chandler, Ph.D., director of the HEALing Communities Study at NIDA. “This is an incredible feat for implementation science, and shows that when we provide communities with an infrastructure to make data-driven decisions, they are able to effectively implement evidence-based practices based on their unique needs.”

The HEALing Communities Study was supported and carried out in partnership between the National Institute of Health’s National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) through the NIH HEAL Initiative.

Source: https://nida.nih.gov/news-events/news-releases/2024/06/nih-funded-intervention-did-not-impact-opioid-related-overdose-death-rates-over-evaluation-period

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

WHYY (PBS) 14th June 2024

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/

Original Investigation – Substance Use and Addiction
July 17, 2024

Melinda Campopiano von Klimo, MD1Laura Nolan, BA1Michelle Corbin, MBA2et alLisa Farinelli, PhD, MBA, RN, CCRP, OHCC2Jarratt D. Pytell, MD3Caty Simon4,5,6Stephanie T. Weiss, MD, PhD2Wilson M. Compton, MD, MPE2

JAMA Netw Open. 2024;7(7):e2420837. doi:10.1001/jamanetworkopen.2024.20837
Key Points

Question  What reasons do physicians give for not addressing substance use and addiction in their clinical practice?

Findings  In this systematic review of 283 articles, the institutional environment (81.2% of articles) was the most common reason given for physicians not intervening in addiction, followed by lack of skill (73.9%), cognitive capacity (73.5%), and knowledge (71.9%).

Meaning  These findings suggest effort should be directed at creating institutional environments that facilitate delivery of evidence-based addiction care while improving access to both education and training opportunities for physicians to practice necessary skills.

Abstract

Importance  The overdose epidemic continues in the US, with 107 941 overdose deaths in 2022 and countless lives affected by the addiction crisis. Although widespread efforts to train and support physicians to implement medications and other evidence-based substance use disorder interventions have been ongoing, adoption of these evidence-based practices (EBPs) by physicians remains low.

Objective  To describe physician-reported reasons for reluctance to address substance use and addiction in their clinical practices using screening, treatment, harm reduction, or recovery support interventions.

Data Sources  A literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network was conducted and returned articles published from January 1, 1960, through October 5, 2021.

Study Selection  Publications that included physicians, discussed substance use interventions, and presented data on reasons for reluctance to intervene in addiction were included.

Data Extraction and Synthesis  Two reviewers (L.N., M.C., L.F., J.P., C.S., and S.W.) independently reviewed each publication; a third reviewer resolved discordant votes (M.C. and W.C.). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the theoretical domains framework was used to systematically extract reluctance reasons.

Main Outcomes and Measures  The primary outcome was reasons for physician reluctance to address substance use disorder. The association of reasons for reluctance with practice setting and drug type was also measured. Reasons and other variables were determined according to predefined criteria.

Results  A total of 183 of 9308 returned studies reporting data collected from 66 732 physicians were included. Most studies reported survey data. Alcohol, nicotine, and opioids were the most often studied substances; screening and treatment were the most often studied interventions. The most common reluctance reasons were lack of institutional support (173 of 213 articles [81.2%]), knowledge (174 of 242 articles [71.9%]), skill (170 of 230 articles [73.9%]), and cognitive capacity (136 of 185 articles [73.5%]). Reimbursement concerns were also noted. Bivariate analysis revealed associations between these reasons and physician specialty, intervention type, and drug.

Conclusions and Relevance  In this systematic review of reasons for physician reluctance to intervene in addiction, the most common reasons were lack of institutional support, knowledge, skill, and cognitive capacity. Targeting these reasons with education and training, policy development, and program implementation may improve adoption by physicians of EBPs for substance use and addiction care. Future studies of physician-reported reasons for reluctance to adopt EBPs may be improved through use of a theoretical framework and improved adherence to and reporting of survey development best practices; development of a validated survey instrument may further improve study results.

Introduction
NDPA WEBSITE:  Note – In the interests of relative brevity, the References have been omitted from this published version.

Overdose is a leading cause of injury-related death in the US,1 with 107 941 such deaths occurring in 20222 and annual deaths due to alcohol exceeding 140 000 from 2015 to 2019.3 The more than 46.3 million people in the US with a past-year substance use disorder4 and a nationwide economic impact of alcohol misuse and illicit drug use that tops $442 billion5 further evidences the magnitude of this crisis.

A variety of safe and effective evidence-based practices (EBPs) to identify, reduce the morbidity and mortality of, and treat substance use disorders exist. Examples include screening, brief intervention, and referral to treatment,610 as well as behavioral therapies and pharmacotherapies for nicotine, alcohol, and opioid use disorders.1113 Furthermore, harm reduction approaches (eg, naloxone training and coprescribing, drug checking and testing, and syringe service programs) offer significant individual and public health benefits for people who use drugs and for those who do not have abstinence-based treatment goals.1416

Clinician adoption of EBPs is necessary; however, screening for substance use disorders remains low,7 creating missed opportunities to intervene in harmful substance use or recognize and discuss potential progression to a severe disorder. Treatment capacity is inadequate to meet demand,17 with only 6.3% of people with a past-year substance use disorder receiving treatment in the US in 2021.4 Our goal is to summarize published data on physician-described barriers to adoption of EBPs for addiction in clinical practice and recommend actions to address them.

Methods
Data Sources and Searches

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. The search strategy was developed iteratively with a National Library of Medicine informationist specializing in systematic reviews. We applied this strategy on October 4, 2021, to PubMed, Embase, and Scopus and on October 5, 2021, to medRxiv and SSRN Medical Research Network. In addition, a gray literature search of relevant government and nongovernment websites was conducted on October 5, 2021. We found no previous similar systematic reviews. The systematic review protocol was registered in PROSPERO (CRD42022286208) and accepted on January 14, 2022.

Study Selection

A 12-person team used Covidence to apply exclusion criteria first to the title and abstract of each study then to the full text of studies not already excluded. Two people (L.N., M.C., L.F., J.P., C.S., and S.W.) reviewed each study in both rounds. Discordant opinions were resolved by a third reviewer (M.C. and W.C.). To be included, the study had to present data on: (1) physicians at any practice level; (2) any substance use intervention(s) (Box); and (3) physician reasons for reluctance to intervene in addiction. Studies not in English, letters, editorials, narrative reviews, and commentaries were excluded. Data collection on reasons for reluctance were systemized using the theoretical domains framework (TDF),18,19 a comprehensive approach for identifying behavioral determinants and for assessing implementation problems (eg, clinicians’ behavior) to inform intervention development. The team created a data extraction template with 10 reluctance reason categories (Box). We did not formally assess risk of bias in included studies because few used experimental or controlled study designs. Due to patterns observed during data extraction, the team approved the ad hoc collection of data on factors (eg, using a theoretical framework, obtaining target audience input in survey design, and piloting surveys) that could affect the internal validity of individual studies or precision of results. We conducted a limited exploration of facilitators because we observed that many included studies provided at least some data on possible facilitators of intervention in addiction.

Definitions of Intervention Type and Reluctance Reasons

Intervention type and definition
  • Harm reduction: syringe services, overdose prevention, naloxone, or drug user health.

  • Screening and assessment: screening, assessment of positive screening, or diagnosis.

  • Treatment: brief intervention, medication management, or behavioral services.

  • Recovery support: care coordination, care integration, or relapse prevention.

Reason and definitiona
  • Knowledge: beliefs about having the necessary knowledge, awareness, or understanding, including knowledge of condition or scientific rationale, procedural knowledge, or knowledge of task environment.

  • Institutional environment: beliefs about support from institution or employer, including material resources, organizational culture, competing demands.

  • Skills: beliefs about having the necessary skills, ability, or proficiency to deliver the intervention.

  • Cognitive capacity: beliefs about the cognitive capacity to manage a level of expected complexity of care, possibly related to cognitive overload and mental fatigue.

  • Expectation of benefit: beliefs about the likelihood of the patient benefiting or the course of the disease being altered due to the intervention.

  • Social influences: beliefs about public or community acceptance or support for the intervention, including willingness to allocate or develop needed resources.

  • Emotion: feelings of fear, dislike, worry, negative judgement, worthiness of patient population.

  • Relationship: concern about harming or losing the patient-physician relationship by causing offense, provoking avoidance, or other negative consequence.

  • Reinforcement: beliefs about the adequacy of reimbursement, professional rewards, and other positive reinforcement.

  • Professional role/identity: beliefs about professional role, boundaries, and group identity, excluding the intervention.

a Reasons are derived from the theoretical domains framework, a comprehensive approach for identifying behavioral determinants and assessing implementation problems (eg, clinicians’ behavior) to inform intervention development.

 

Data Analysis

We conducted a series of quantitative analyses using SPSS, version 27 (IBM). Analyses were selected based on their purpose; independent variable; dependent variable; and statistical requirements, including measurement levels. We examined reasons for reluctance by specialty, intervention, drug type, and year and common combinations of reasons for reluctance using bivariate analysis and cross-tabulation. We conducted a regression analysis of reasons for reluctance by year. Statistical significance was considered a 2-sided P value less than .05. The exploratory analyses of ad hoc study quality data were not part of the planned analysis and are descriptive only. We used Atlas.ti version 24 (Atlas.ti) to conduct thematic analysis to examine facilitators using the following themes: knowledge and skills, intrapersonal and interpersonal factors, infrastructure, and regulation reform.

Results
Study Characteristics

Our search yielded 9308 studies published between January 1, 1960, and October 5, 2021, with 1280 remaining after removal of duplicates and 552 assessed for eligibility (eFigure 1 in Supplement 1). Of 283 studies20302 included (eTable 1 in Supplement 1), 97.30% were published in 2000 or later (Table 1). The number of studies increased over time. For example, 4 studies89,156,184,236were published in 2000 and 2133,48,49,66,68,75,77,79,93,107,108,113,139,142,148,240,251,255,302,306,313 in 2021, with a high of 31 8,27,47,50,52,54,69,74,92,100,114,121,146,147,161,165,174,182,191,193,199,204,206,209,221,247,263,270,275,287,300 in 2020 (eTable 2, eTable 3, eTable 4, eTable 5, and eFigure 2 in Supplement 1). Together, the included studies describe the views of 66 732 physicians who largely practiced general practice, internal medicine, or family medicine primarily in an office setting in the US. Most studies reported survey-based research results. Of the 4 general categories of addiction interventions (Table 2), treatment was most often addressed, followed by screening and assessment, with harm reduction and recovery support least discussed. Some studies addressed more than 1 intervention. Alcohol (86 studies20,21,23,25,26,29,31,34,36,38,41,44,51,53,54,57,59,60,62,6972,81,82,86,88,89,94,95,103,105,111,113,117,119,123127,131,132,138,141,150,153,155,158,160,162,164,168,170,171,173,176,191193,196201,204,205,210,219,235,237,248,250,254,256,258,271,281,283,285,291,294,296,299,300), nicotine (30 studies28,40,48,49,52,61,73,85,97,109,118,129,134,140,142,149,179,188,190,212,218,223,231,249,252,265,270,286,288,298), and opioids (104 studies30,32,33,35,37,42,46,47,50,55,56,58,64,66,7480,83,84,87,9092,98100,104,106108,110,112,114,115,121,122,130,133,135,137,139,143,144,146148,151,152,154,156,163,165,167,172,174,180,182,184,186,189,202,203,206,207,213216,221,222,225228,238240,242245,247,251,253,255,257,259,262,269,272,275,277,280,282,284,287,290,292,293,302) were most often studied alone. Among studies reporting on multiple drugs (44 studies22,39,43,45,63,65,67,68,93,96,101,102,116,120,136,145,166,181,183,185,194,195,208,209,217,220,230,232234,241,246,260,263,264,267,268,273,274,278,279,289,295,297), alcohol was included most often (38 studies45,63,65,67,68,93,96,101,102,116,120,136,145,166,181,183,194,195,208,209,217,230,232234,241,246,260,264,267,268,273,274,278,279,289,295,297). Other substances were often reported as “other” or merely “drugs.” Cross-tabulations of each reason for reluctance with each of the most common specialties, interventions, and drugs produced no significant results; consequently, no P values are reported (Table 2). While this systematic review is of physician reluctance, 110 studies20,2325,28,30,31,33,34,39,42,44,47,48,50,52,54,57,59,63,64,6670,87,88,90,92,93,95,99,101,103107,109,111113,116,120,122,123,126,129,134,136,138,139,143,146,147,151,156,157,159,162,166,167,169,173,174,177,178,183,186,189,190,192,194,195,199201,203,205,206,209,211,217,221,225,229,235,236,243245,251,257,260,261,266,269,270,275,277,280,283,286,287,290,291,297,299,302 mentioned possible facilitators of physician engagement.

Physician Reluctance

Most studies did not gather or report data on all reasons. When queried, institutional environment (173 of 213 articles [81.2%]20,22,2527,3033,35,37,38,4044,46,47,4951,5464,66,68,7478,80,8284,86,87,8993,95,97,99,100,104,106110,112114,116,117,121124,126,127,129,134139,143,144,146148,150,151,153155,157159,161165,167,169176,179,180,182,183,185,186,189,192,195,198,199,201204,206,207,209,211,216221,223,226,228230,232234,236,238,239,241243,245,247,251,252,257261,263265,268,269,271,272,275,277,280,284,287,290,291,293,295,299,301,302) was the most common reason, followed by lack of skill (170 of 230 articles [73.9%]2022,2433,35,3739,4749,51,5355,58,59,61,6368,75,76,78,8082,84,85,88,89,9193,95,97100,102107,109114,116121,123125,130132,134,136,138,139,142,143,145,147,149,150,152,154,159161,167,168,172174,176,178,180,182,183,186,188,190,191,193,194,197202,204,206211,213,214,216,218221,224226,229,231,233,235,236,238,241,242,246,247,249,256,259,264266,268,269,271,273,274,276279,281283,285287,290295,297,298,301,302), cognitive capacity (136 of 185 articles [73.5%]22,25,26,30,32,34,37,40,41,4749,52,55,5861,6366,68,69,71,74,75,77,78,80,82,85,8791,93,95,97,100,101,104107,109114,116,117,119,120,122126,129,134136,138,139,142,146151,154156,159162,167,172,174,180,181,185187,190192,196199,205,206,209,211,213,214,216,217,219,225,229232,235,237,239,241243,254,256,260,264,265,268270,272,275,277,283,286,287,290292,299,301,302), and knowledge (174 of 242 articles [71.9%]2022,2533,36,37,39,42,43,49,5359,61,62,6466,6870,73,76,78,81,82,84,85,9193,95,97100,102107,109,110,113,114,116121,126,128,130,131,136,138,139,141143,147,149152,154,155,157,159161,163,166168,170174,176180,182186,188,190194,197204,206210,212215,219,221,224,226,236238,241,242,244,246,247,251,252,256258,264,266269,271,273,274,276281,283288,292295,297302); and social influences (121 of 184 articles [65.8%]26,27,3032,41,42,46,47,49,51,57,58,60,62,63,68,71,77,79,80,82,83,88,90,92,95,99,101,102,106110,112114,118,121124,126,127,129,134138,146,147,151,153,155,157159,161,165,167,169,170,176,177,180,182,185,189,195,197208,210212,216,217,219,221,223,227,228,233235,238,242,245,247,249,254,255,257,260,261,264,266,268,269,282,283,286,287,289,291,296298,301,302) (Table 2). We conducted bivariate analyses of reasons for reluctance and specialty, drug type, intervention, and time (Table 2; eFigure 3 in Supplement 1). Too few studies of recovery support existed to conduct a bivariate analysis with reasons for reluctance. Analysis of combinations of the top 4 reasons for reluctance found the most often paired reluctance reasons were knowledge and skill (135 of 221 articles [61.1%]2022,2533,37,39,49,5355,58,59,61,6466,68,76,78,81,82,84,85,9193,95,97100,102107,109,110,113,114,116121,130,131,136,138,139,142,143,147,149,150,152,154,159161,167,168,172174,176,178,180,182,183,186,188,190,191,193,194,197202,204,206210,213,214,219,221,224,226,236,238,241,242,246,247,256,264,266,268,269,271,273,274,276279,281,283,285287,292295,297,298,301,302), followed by cognitive capacity and institutional environment (99 of 165 articles [60.0%]22,25,26,30,32,37,40,41,47,49,55,5861,63,64,66,68,74,75,77,78,80,82,87,8991,93,95,97,100,104,106,107,109,110,112114,116,117,122124,126,129,134136,138,139,146148,150,151,154,155,159,161,162,167,172,174,180,185,186,192,198,199,206,209,211,216,217,219,229,230,232,239,241243,260,264,265,268,269,272,275,277,287,290,291,299,301,302) (Table 3). Institutional environment appeared in combination with other reasons more often than any other reason (7 of 12 pairings). Reasons not in our data extraction template were described in a few studies, including lack of demand (13 articles87,92,112,122,143,167,171,214,216,232,257,280,292), cost to the patient (8 articles58,69,148,155,171,174,288,292), and patient refusal (6 articles61,146,170,174,182,206). Analysis of the trend over time for each reason for reluctance revealed a significant increase in identification of social influence (F1,20 = 4.91; P = .04) and relationship (F1,20 = 4.54; P = .046) (eFigure 3 in Supplement 1). We extracted exemplar text from included studies for the top 4 reasons for reluctance (Table 4), discussed in the following section.

Institutional Environment

Reasons for reluctance related to the institutional environment included lack of trained staff66,154,167,182,186,207,242,260 or resources to train staff,59,92,221 acceptance of addiction interventions by staff107,259 or leadership,57,80,155,169,175,261,275 and clinician backup.54,56,64,75,76,90 Regulatory and liability concerns were frequently reported,32,35,50,75,76,87,90,99,107,163,165,167,174,245,259,261 as were record-keeping or confidentiality concerns207,259,275 and staff time required for prior authorizations.92 Often mentioned were also cost to the patient or lack of insurance coverage,148,155,170,171,173,174,182 along with medication unavailability at pharmacies95,144,148,170 and the absence of population-specific patient education materials.260,291 Less frequently cited but noteworthy reasons for reluctance include contractual limitations,291 nonexistent or unimplemented treatment algorithms,99,287 mental health programs not accepting patients with addiction,264 addiction treatment programs rejecting patients deemed insufficiently ready to change or having difficulty matching the level of care needed,229 and difficulty obtaining records from addiction treatment programs.107 Reimbursement can be viewed as a component of institutional environment. In the TDF, reimbursement is 1 part of reinforcement as a reason for reluctance (Box). While reinforcement was 1 of the 2 least often identified reasons for reluctance, data specific to reimbursement was extracted because it is a perennial point of concern in adopting evidence-based interventions for addiction. Physician reimbursement was viewed as insufficient to cover both the staff time necessary to intervene in addiction and the expense of additional staff training.174,207,277 Medicaid reimbursement was specifically highlighted as inadequate.186 In some cases, physicians perceived the reimbursement to be inadequate but were not certain of the reimbursed amount.56

Lack of Knowledge

In studies identifying lack of knowledge as a reason for reluctance, knowledge was more deficient for treatment than for screening or diagnosis and for drug use more than for alcohol or tobacco use.20,65,70,93,99,102,117,152,194,221,252,273 Physicians were unfamiliar with the evidence for substance use disorders as biomedical conditions,119,138,199,257 harm reduction strategies,58,154 and screening for risky substance use.59,161 Some physicians lacked awareness of the extent of substance use by their patients.256

Lack of Skill

Physicians reported lacking skills to conduct interventions effective enough to produce behavior change, including counseling21,38,51,59,117,291 and brief intervention.93,209,229 They also described a lack of skill needed to initiate or manage treatment,92,152,221,273 especially for substance use disorders other than alcohol or tobacco.63,194 In some studies, they equated their lack of skill with lack of experience with observing or delivering a substance use disorder intervention under supervision.22,75,91,238,256 Inabilities to assemble or demonstrate naloxone administration devices58,277 or to deliver appropriate training in its use to patients99 were also noted.

Lack of Cognitive Capacity

Lack of cognitive capacity was not often characterized beyond a general sense of overwhelm with clinical tasks (eg, “just too busy”)64,291 and the need to prioritize patients’ competing needs.58,107,109,268 In some cases, physicians perceived intervening in addiction as too time-consuming, both during the appointment and for monitoring,69,87,90,93,287 or that addiction treatment demand would be too great.66,75,91 Even delegating screening to other clinical team members was viewed as diverting time from the physician visit229; available tools were considered time-consuming.260 Some physicians expected meeting the care needs of patients with addiction to be too time-consuming.

Facilitators

We analyzed 4 main themes related to facilitators. First, physicians need the knowledge and skills to intervene; they need adequate education and training in areas like managing pharmacology. Second, intrapersonal and interpersonal factors exist that facilitate physician intervention. Intrapersonal factors include physician characteristics (eg, work experience, confidence, and practice type) and motivation (eg, desire to improve patient outcomes, reimbursement, and understanding addiction as within their scope of practice). Interpersonal factors include the physician-patient relationship, specifically the patient characteristics that may compel the physician to intervene (eg, the patient is receptive to help). Third, an infrastructure is needed that supports physician interventions and includes institutional changes at the practice level to implement protocols to standardize care (eg, screening and improved technology). An environment that fosters collaboration with other professionals or entities (eg, multidisciplinary teams and referral systems) and offers resources that would support the intervention (eg, materials or tools for use with patients, follow-up care, or treatment facilities) is also essential. Finally, regulation reforms (eg, eliminating prior authorization requirements, expanding substance use disorder insurance coverage, and simplifying laws and policies governing prescribing and medication distribution to patients) would facilitate physician intervention.

Discussion

The number and growth of publications meeting inclusion criteria for this systematic review demonstrates increasing interest in the perceived and actual barriers to physician engagement with addiction in clinical practice. The significant increase in social influence and relationship as reasons for reluctance over time may indicate increased awareness of stigma and associated social harms. Regarding intervention types, the availability of effective alcohol use disorder and opioid use disorder pharmacotherapies likely accounts for the literature’s focus on those therapies, corresponding with efforts to increase access to medications for opioid use disorder and to promote the adoption of screening, brief intervention, and referral to treatment practices. As the evidence base for a wider array of harm reduction strategies grows, it will be important to understand and address physicians’ perceived and actual barriers to their acceptance and adoption of those strategies. Information is limited on the adoption of recovery support interventions by physicians, a finding that also merits investigation.

That institutional environment is associated with physician reluctance to intervene may not surprise practicing clinicians. The pairing of institutional environment and cognitive capacity may signify the cost in time physicians expend overcoming institutional barriers to EBP for addiction (eg, inefficient workflows and communication and coordination of care across silos). The association of institutional environment with treatment and opioids may reflect the push to increase buprenorphine access despite regulatory impediments and health systems being unprepared for this responsibility.

Strategies to reduce physician reluctance related to institutional environment include greater commitment by health systems to make essential workflow and staffing changes, the breaking down of barriers between addiction services and both medical and mental health care, and commitment by insurers to provide reimbursement that covers the actual cost of providing addiction interventions. The analysis of facilitators supports a specific need for protocols to adequately intervene with patients with either at-risk substance use or substance use disorders. Institutional environment changes (eg, investing in staffing and staff training, implementing standard practices or protocols, and conducting addiction-specific quality assurance) could also facilitate intervention.

Lack of knowledge and skill are top reasons for reluctance, both separately and combined. It is unclear whether survey respondents understood knowledge and skill as the researchers intended because these terms were rarely defined in the studies. Only a few studies allowed for future replication by including objective measures of knowledge or skill (eg, counting successfully delivered services and interviewing patients).

True lack of knowledge and skill can be understood in several ways, including as a manifestation of the volume of information practicing clinicians are required to possess, acquire, and update. For example, physicians need updated information on dosing, pharmacology, and overall efficacy of interventions and medications. This challenge is made harder if interventions (eg, screening practices, initiating pharmacotherapy) are insufficiently adapted for different practice settings. Delivering these interventions effectively, efficiently, and in a nonstigmatizing manner requires skill mastery. Physicians, like other clinicians, acquire their skills by observing and then practicing under supervision. Medical education and postgraduate training have only recently begun to prepare physicians for these tasks.303,304

Ongoing training is critical for physicians to acquire and apply advanced skills in the care of this patient population,305307 but few opportunities exist to observe and be observed practicing new skills once required medical training is complete. The analysis of facilitators suggests skill training should focus on brief intervention (eg, screening or assessment) and on communication with patients. Trainings accessible to physicians (eg, free or incentivized, hands-on, or delivered in clinical settings) and delivered by specialized trainers and/or mentors would facilitate the growth of a pool of experts to intervene in substance use. Physicians who expand their knowledge and skills should be eligible for continuing medical education credits and increased compensation.

Other reasons for reluctance (eg, negative social influences, negative emotions toward people who use drugs, and fear of harming the relationship with the patient by discussing substance use) could each be viewed as manifestations of stigma associated with substance use disorder and its treatment. Lack of demand may also reflect stigma if it is a manifestation of unwillingness on the part of patients to seek help due to fear of social, legal, and moral judgement or a presumption by the physician that there is no addiction in their community.

These reasons may diminish if effective public and professional education, in particular those developed and led by patient groups or by people who use drugs,308312 are delivered to counter stigma.313 The analysis of facilitators suggests the following may be helpful: educational materials for patients and families, community outreach, and public health campaigns promoting nonstigmatizing language.

Reducing stigma will not be enough to address fear of harming the patient relationship, especially for physicians who care for minors and other populations that may be subject to punitive consequences of addiction. These physicians must consider additional confidentiality requirements, and their fear of harming the patient by triggering negative social and legal consequences may be more of a deterrent than previously considered. Interpersonal aspects of the patient-physician relationship and how they create reluctance or facilitate intervention are not well understood, although the analysis of facilitators shows that physicians may be motivated to intervene in substance use disorders when they have an established relationship with the patient, the patient is receptive to help, and/or the desire to improve patient outcomes is strong. Future research should examine unintended impacts of increased physician intervention in addiction like strain on the physician-patient relationship, less opportunity to meet other health care needs, and stigmatizing interactions with other health care clinicians due to the substance use disorder diagnosis being more widely documented.

Limitations

This study has limitations. Inconsistent use of terms across included studies increased the complexity and interpretation of this analysis, but analysis of a sample this size can still inform research and policy. Studies were often developed without the benefit of a theoretical framework. Survey development lacked or failed to report participation of the audience of focus and/or was not piloted, raising concerns about the validity and applicability of results. During the years this systematic review covered, new medications and formulations became available, making comparison across decades challenging. The unregulated drug market also evolved, resulting in changes to illicit substances, methods of using them, and the regulatory environment in which clinicians address substance use. This review was limited to physicians, some of whom may have participated in more than 1 survey or focus group in the included studies. Although the results are relevant to the practice environment of many clinicians, including those specializing in addiction, they do not reflect the unique challenges that may be encountered by specific disciplines. Although we collected and described data about facilitators, the original search was not designed specifically to retrieve publications about facilitators of intervention in addiction.

Conclusions

These data suggest that policy, regulatory, or accreditation changes are needed to systematically address institutional barriers, as well as increases to physician reimbursement and opportunities for clinically relevant training that provides both skill development and knowledge gain. Another systematic review of facilitators and reluctance among other clinical disciplines may refine the recommendations presented here. Future studies of clinician reluctance to adopt EBPs for addiction need to be of higher quality. They, at a minimum, should employ a theoretical framework and adhere to survey development best practices or use a validated survey instrument.

Article Information

Accepted for Publication: May 7, 2024.

Published: July 17, 2024. doi:10.1001/jamanetworkopen.2024.20837

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821497

By Killian Meara

For National Fentanyl Awareness Day, Drug Topics talked with Scott H. Silverman about how public health leaders can address the fentanyl crisis and the best ways to educate the public on the dangers of fentanyl use.

The opioid epidemic in the United States stretches back to the 1990s, when the synthetic opioid oxycodone hydrochloride was first introduced as a medication to treat moderate to severe pain and chronic pain. Since then, opioid overdose deaths in the country have skyrocketed, with data from the CDC showing there were over 109000 in 2022, with nearly 70% due to synthetic opioids.1

The primary driver behind the rise in synthetic opioid-related overdose deaths is fentanyl. Used to treat complex pain conditions and pain related to surgery, fentanyl is 50 times stronger than heroin and 100 times stronger than morphine.2 That means even a small dose of the synthetic opioid can be potentially lethal for people who have no tolerance.

According to some research, while fentanyl use is now widespread, a majority of users do not intend to use it.This is largely because its introduction into other illicit substances has become pervasive. The synthetic opioid has been found in heroin, cocaine, methamphetamines, opioid analgesics, amphetamines, and benzodiazepines.3 Because of the increased threat of overdose fentanyl poses, it is critical to bring awareness to the drug and to implement harm reduction services to mitigate risk.

National Fentanyl Awareness Day, held annually on May 7, aims to educate the public about the dangers of fentanyl use. This year, Drug Topics talked with Scott H. Silverman, a crisis coach, behavioral health consultant, and team lead for the substance abuse recovery program Confidential Recovery, about how public health leaders can address the fentanyl crisis, challenges in accessing treatment and support, and the best ways to educate the public on the dangers of fentanyl use.

Drug Topics: What do you believe are the most important priorities for policymakers, healthcare providers, and community leaders to address in the fentanyl crisis?

Scott H. Silverman:The most important priority for the fentanyl crisis is to make it as important as the COVID-19 pandemic. If we don’t, the morbidity rate will continue to grow and the fentanyl distributors will see that the US doesn’t really care, so they will continue to target us.

Real-time data is crucial to make changes. For example, the medical examiners should be communicating on a national level to share what percentage of the overdoses are solely from fentanyl or fentanyl-laced drugs. We need real-time demographics because we can’t wait 18 months to find out the statistics and what happened in 2022. We must find out as quickly as possible to address this crisis head-on. It must be made a priority by federal, state and local governments, because they are the only ones that can help put a stop to this. Overall, data-driven information in a time-sensitive manner is going to be critical.

Drug Topics: From your perspective, what are the most pressing challenges in accessing effective treatment and support services for individuals struggling with opioid addiction?

Silverman: I don’t believe the insurance industry understands what they’ve got in front of them. It’s a benefit-driven industry, and the industry needs to take a good look at themselves and figure out how they are going to really help people. We’ve seen the current President reduce the cost of pharmaceuticals and pharmaceutical companies are still doing fine, so they know how to create systemic change, but it needs to become a priority.

Drug Topics: How can communities, organizations, and individuals work together to prevent opioid-related overdoses and deaths?

Silverman: Education and prevention. Right now, the big conversation is around [naloxone (Narcan)], the drug that reverses overdoses. The issue is we are giving a lot of people that drug after they overdose, but how do we work hard to educate and incentivize people who are making a conscious decision to not put something in their body? That’s going to require a ton of education and a ton of prevention, which social media could really help make the change that’s needed for young people specifically. Kids are getting iPhones and iPads now in the single-digit ages, so why not make social media a learning opportunity to educate and save lives?

Drug Topics: What do you think are the most effective ways to educate the public about the dangers of fentanyl misuse?

Silverman: Common sense messaging is the most effective way to educate the public. Using simple messages like, “one pill can kill,” can really make a difference. The DEA came up with that phrase knowing that it’s a poison and the people that make it don’t care if their consumer dies. The government is trying to tell people about this issue, but the real question for consumers is,“Are you listening and are you seeking the knowledge?” So, how do we incentivize and find creative ways to reach them? This commonsense messaging doesn’t need to be wrapped into your dinner napkin every night, but it should be a part of the discussion every week with the family. The education aspect really comes with family discussion.

Drug Topics: Looking ahead, what do you hope to see in terms of progress and awareness surrounding fentanyl misuse and overdose prevention?

Silverman: I hope the morbidity rate declines. I would love to stop going to funerals and we shouldn’t say, “That’s sad, but it’s somebody else’s kid.” The data shows that 42% of adults in the country know somebody or know of somebody who died of an overdose. There’s no other disease that has that high of a morbidity rate that people know about. If it’s that high of a morbidity rate, why aren’t we doing more? Whatever that’s defined as and putting more strength at the border, although we have multiple borders, you can ship these drugs over in a parachute, float it in with a drone, bring it in through the mail and you can even make it now. There’s a lot of money around it too, a lot of young people are buying these materials on the dark web and making it themselves.

Source:  https://www.drugtopics.com/view/fentanyl-education-prevention-key-to-ending-crisis-in-us

 

 

The initiative aims to reduce substance use-related harms among young people across Canada through the Icelandic Prevention Model, with support and expertise from Planet Youth.͏ ͏ ͏

 

No community in Canada has been left untouched by the substance use-related harms and the toxic illegal drug supply and overdose crisis. Efforts to prevent substance use, especially among youth, are critical, and by strengthening communities and environment of youth, they will be at lesser risk of initiating substance use.

 

On June 26, the Honorable Ya’ara Saks, Minister of Mental Health and Addictions and Associate Minister of Health, announced the Canadian government’s support for the Youth Substance Use Prevention Program (YSUPP). The event took place in Glace Bay, Novia Scotia in the Undercurrent youth center which provides leisure activities for the youth in the area. The initiative aims to reduce substance use-related harms among young people across Canada through the implementation of the Icelandic Prevention Model (IPM), with support and expertise from Planet Youth.

 

The initial stage of this initiative will secure funding for seven projects in British Columbia, Saskatchewan, Ontario, and Nova Scotia. Which will be added to the already started seven Planet Youth initiatives in other parts of Canada. These projects will focus on the Canadian adaptation and implementation of the Icelandic Prevention Model and its collaborative approach to preventing substance use harms among youth. With Planet Youth’s guidance, the IPM emphasizes a community-driven strategy to address the root causes of substance use.

 

These projects will engage diverse communities and sectors, including First Nations, schools, service providers, community leaders, and young people with lived and living experience. Their participation will be crucial in evaluating the IPM within the Canadian context, ensuring that the model is effectively tailored to meet the unique needs of Canadian youth.

 

Additionally, Renison University College, affiliated with the University of Waterloo, will receive funding to establish a new Knowledge Development and Exchange Hub for Youth Substance Use Prevention. Planet Youth experts will train the Hub to provide guidance and training on the IPM’s implementation in Canada. The Hub will lead a pan-Canadian youth substance use prevention community of practice, facilitating the sharing of information and best practices among various projects.

 

Preventing and reducing youth substance use through YSUPP is a key component of the Canadian Drugs and Substances Strategy. The Canadian government is committed to continuing this critical work in collaboration with all levels of government, partners, Indigenous communities, stakeholders, and local organizations. These efforts aim to reduce substance use-related harms, ensure comprehensive support for those in need, and ultimately, save lives.

 

Source: Public Health Canada

 

Links:

EHF Address: Planet Youth ehf. Lagmúla 6, 108, Reykjavik, Iceland.

By Jody Boulay on Friday, July 5, 2024

It seems as all communities have been impacted by the problems associated with substance use and drug overdose. These problems extend into the family unit, with people 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.

Locally, Osceola County offers many addiction recovery resources, such as House of Freedom, Turning Point Counseling, and Park Place Behavioral Health in Kissimmee, as well as a substance abuse hotline in English (407-870-8282) and Spanish (407-240-1181).

Most importantly, amid the growing opioid epidemic, there is significant attention placed on preventing opioid overdose. In June, the Florida Department of Health in Osceola County hosted an event to help raise awareness about the dangers of overdosing called Revive Awareness Day, where free naloxone was available. (Residents can also find naloxone by calling the Osceola Department of Health at 407-343-2000.)

Drug education and prevention programs in Florida have made a significant impact, especially among youth. In addition to the long-term decline in alcohol and cigarette use, Florida students have also reported long-term reductions in the use of illicit drugs other than marijuana. However, while alcohol use is down, highrisk drinking behavior is still common.

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.

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—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 seem like an easy escape from the problems of life.

Additionally, environment and family history are contributing factors. Children 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 non-profit organizations providing prevention and education. 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, a mother of two with a passion for helping others, works as a Community Outreach Coordinator for DRS to help spread awareness of the dangers of drugs and alcohol.

 

Source: https://www.aroundosceola.com/opinion/support-local-drug-education-and-prevention-programs

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

According to the World Health Organisation, substance abuse claims the lives of over 500,000 people annually, with a staggering 35 million people worldwide suffering from drug use disorders.

Perhaps the most heart breaking aspect of this crisis is its impact on the youth.

The United Nations Office on Drugs and Crime reports that approximately 5.6 per cent of the global population aged 15-64 has used drugs at least once in the past year, with the highest prevalence among those aged 18-25.

Today the impact of drug use manifests in the society in several ways including such violent crimes as kidnapping, assassination, armed robbery and insurgency.

One of the states where this is rampant is Katsina where wanton destruction of lives and herds, kidnapping, raping and invasion of communities by criminal elements is now almost the order of the day.

“We must get to the root of the problem, and the root of the problem is drug abuse by the teeming youths in the state. We know that these inhumane acts cannot be committed without the influence of drugs“, worried Gov. Dikko Radda said during a visit to NDLEA chairman, retired Brig-Gen Buba Marwa.

He has support from Ajentekebia Harry, Country Director of Logistics Nigeria, Continent Afrique, and NGO.

“Many of the criminal and terrorist activities you see today in Nigeria are drug induced. These drugs have the capacity to simulate unholy acts that can plunge the nation into chaos,” he said.

The consequences of substance abuse among youth are far-reaching, affecting academic performance, mental health, and future prospects.

According to the National Institute on Drug Abuse, U.S. teenagers who use drugs are at an increased risk of developing addiction later in life, as well as experiencing cognitive impairments and mental health issues

In the face of these staggering statistics, the role of good parenting emerges as a beacon of hope and a powerful catalyst for change. Numerous studies have demonstrated the protective influence of strong family bonds, open communication, and positive role modeling in preventing substance abuse among youth.

The Substance Abuse and Mental Health Services Administration, reports that children with involved parents are up to 50 per cent less likely to engage in substance abuse.

Furthermore, a study by the National Centre on Addiction and Substance Abuse found that teenagers who frequently have family dinners are 33 per cent less likely to use drugs, alcohol, or tobacco.

By fostering a nurturing environment, instilling resilience, and providing guidance, good parents can equip their children with the tools to navigate the challenges of life without resorting to substance abuse.

While the role of good parenting is undeniably crucial, addressing the pervasive issue of substance abuse requires a multifaceted approach that involves collaboration among families, communities, and policymakers.

By empowering families, strengthening community support systems, and implementing effective policies, we can forge a path towards a drug-free society – one where the next generation can thrive, unencumbered by the devastating consequences of substance abuse.

The Federal Government says it recognises the role of civil society organisations in combating drug abuse among young people.

Consequently, it is prepared to partner with Vanguard Against Drug Abuse (VGADA), to raise awareness against drug abuse.

It is also prepared to rehabilitate and provide skills for youths affected by substance abuse.

Ayodele Olawande, Minister of State for Youth Development, made the pledge in Abuja when he received Hope Omeiza, Executive Director of VGADA detox centre.

“There is also need to enlighten the parents, especially the mothers at the grassroots, so as to help educate children and youths on drug abuse and illicit trafficking,” he said.

He said that the ministry had been to 19 states and many local government areas to campaign against dangers of drugs, substance abuse and illicit trafficking.

“From our experience, we have two different types of young people today – the formal and the informal. The formal people know and are aware of the dangers of these drugs, but the informal are at the grassroots level.

“We are not engaging the informal people and that is why illicit drug use has been spreading widely to the towns, the villages, and to the grassroots. This is the reason you’ll see me in every community engaging with the stakeholders, the women especially.

“We believe that everything begins from the home; with the mothers talking to their children, it will help curtail the menace to the barest minimum,” he said.

Drawing example from Adamawa, the National Drug and Law Enforcement Agency (NDLEA) paints a grim picture of the drug situation in Nigeria, especially as it affects the youth population.

State Commander of NDLEA, Samson Agboalu, says it has arrested no fewer than 454 suspected illicit drug traffickers/peddlers from June 2023 till date.

Agboalu said the figure reflected a 9.38 per cent decrease from the 501 arrests made in the previous year. While those arrested decreased in Adamawa, drug seizures significantly rose, with a total of 4,732.128 kilogrammes of hard drugs confiscated.

”This is a 75 per cent increase from the 1,164.750 kg seized between June 2022 and June 2023.

“These seizures include a range of substances such as Cannabis Sativa, Methamphetamine (ice), Cocaine, Tramadol, Exol-5, Diazepam tablets, Codeine-based syrup, Rohypnol tablets, and Pentazocine injections.

The curve of conviction of drug offenders has witnessed an upward curve as prosecution efforts and forfeitures from June 2023 till date saw 148 individuals being convicted.

This is a major increase from 115 convictions recorded between June 2022 and June 2023.

“The highest sentences handed down were between10 and five years’ imprisonment, with the least six months.

“Monetary forfeiture recorded an increase, with the sum of N851, 153 forfeited to the Federal Government and deposited into the Treasury Single Account (TSA), compared to N729,480 in the previous year”, he said.

The NDLEA commander called for the adoption of preventive measures as a strategic approach in addressing drug abuse in the state.

While the civil society organisations and relevant government agencies battle drug abuse among youths, many stakeholder believe that winning the war would be a mirage without tackling it from the foundation of the society, the family.

On Feb. 12. NDLEA organised training on Drug Prevention Treatment and Care, DPTC, for spouses of state governors in Abuja.

The event offered the First Lady, Oluremi Tinubu to air her voice on what parents should do to stem drug abuse in the society.

“As mothers, we understand the profound impact that drug abuse can have on our children’s lives. Therefore, it is incumbent upon us to protect, nurture, and guide them towards a future free from the shackles of addiction’’, she said.

The First Lady’s position on the important role of parenting in curbing drug abuse among young people is re-echoed by a medical expert, Taiwo Malomo.

“As parents, especially as mothers, as a matter of urgency, we must rise up to tackle this menace“, says Malomo, a Principal Medical Office, ’’Surgical Emergency Department, University of Abuja Teaching Hospital, Gwagwalada.

Similarly, Dotun Ajiboye, a psycho-socialist, advises parents and guardians to consult a mental health professional immediately they noticed substance use in a child, to save them from drug addiction.

“It is very important for every parent and guardian to know the root cause of substance abuse in their children.

“Parents should give godly guide on how to avoid or live above these triggers,” Ajiboye said in a media report.

Source: https://businessday.ng/features/article/good-parenting-as-catalyst-for-drug-free-society/

 

Mary Brett – in memoriam

Mary Brett, Former biology teacher (30 years at Dr Challoner’s Grammar School for boys, Amersham, Buckinghamshire. UK), Trustee of CanSS (Cannabis Skunk Sense), Member of PandA (Centre for Policy Studies) and former Vice President of Eurad. With regret, it is noted that Mary has recently died, in 2024, after a long illness – her expert contribution to the field of drug prevention and education is to be celebrated, and remembered for the quality of her work throughout.

The paper reproduced here below  is but one example of Mary’s expert contributions to the field.

Executive Summary

Prevention is the policy of this Government but harm-reduction organisations are being consulted for information and evidence—the Advisory Council on Misuse of Drugs (ACMD), Drugscope and the John Moores University Liverpool.

Information on cannabis from these sources is out-of-date, misleading, inaccurate, has huge omissions and is sometimes wrong. It does not stand comparison with current scientific evidence.

Children do not want to take drugs. They want reliable information to be able to refuse them.

Tips on safer usage and “informed choice” have no place in the classroom.

Prevention works.

  1. Current information about drugs being given to this government comes mainly, if not entirely, from harm-reduction organisations. I find this astonishing. The policy of this Coalition Government is prevention.
  2. I had long suspected, and had it confirmed by BBC’s Mark Easton’s blog 20 January 2011, that “Existing members of the council (ACMD) are avowed “harm-reductionists”. Drugscope, a drugs information charity paid for entirely by the taxpayer, has always had a harm reduction policy. We find statements like, “prevention strategies are not able to prevent experimental use” and “harm minimisation reflects the reality that many young people use both legal and illegal substances”. And the John Moores University in Liverpool has been at the forefront of the harm reduction movement since the eighties. Pat O’Hare, President of the International Harm Reduction Association (IHRA), said: “As founder of the first IHRA conference, which took place in Liverpool in 1990, it gives me a great sense of pride to see it coming “home” after being held all over the world in the intervening 20 years”.
  3. FRANK is the official government website providing information to the public, especially children 11–15. I have learned that the information for the recently re-launched FRANK website came from The John Moores University. A member of the FRANK team, Dr Mark Prunty was involved in a commissioned report, “Summary of Health Harms of Drugs” published in August 2011.
  4. Harm reduction has its place in the treatment of addiction, eg reducing the dose till abstinence is attained. But no place in the classroom where well over 90% of children have no intention of ever taking drugs. Harm reduction can and does sometimes act as a green light.
  5. This government says it wants to stop young people from ever starting to use drugs, but that’s not the aim of harm reductionists. They assume children will take drugs anyway, so give them “tips” on taking them more safely, and offer them “informed choice”. And for some reason I have never understood, they always downplay the harmful effects of cannabis—information is vague, inadequate, misleading, out-of-date and sometimes completely wrong.
  6. Brains are not fully developed till the 20s, the risk-taking part developing before the inhibitory area. Children from seven upwards are simply incapable of making the right decision. They need to be protected, not abandoned to make critical life choices. Only 30–40% will ever try drugs—a world away from regular use. What other illegal activities do we invite them to choose—pilfering, graffiti-spraying? Harm reduction advocates are so wrong. Children don’t actually want to take drugs. They want sound, reliable and full information to help them refuse drugs from peer group users who are pressuring them. I know—they’ve told me. Harm reduction policies are tantamount to condoning drug use.
  7. Prevention works. The prevention campaign in USA 1979–1991 saw illicit drug users drop from 23 to 14 million. Cannabis and cocaine use halved. Over 70% abstained from cannabis use because of concern over physical and/or psychological harm (P.R.I.D.E. survey USA 1983). In Sweden, 2010 “last month use” of cannabis was 0.5% (ages15 to 64), European average—3.7%.
  8. Overall, drug use may have fallen in the last 10 years but the last BCS reported that there had been a 1% increase in the “last year” use of cannabis among 16 to 24 year olds in the UK. This amounts to around 55,000 people—no room for complacency.
  9. At a meeting of the FRANK team, Dr Mark Prunty, asked me to send my large scientific report on cannabis (“Cannabis—A general view of its harmful effects”, written for The Social Justice Policy Group, in 2006, fully endorsed by eminent scientists, and regularly updated), and all new research papers that I received. He also had the two books I have written (“Drug Prevention Education” and “Drugs—it’s just not worth it”1). I wasted my time. Why is there no scientific researcher on the FRANK team or at least temporarily co-opted?
  10. One of the John Moore’s staff members, Dr Russell Newcombe helped to pioneer the harm-reduction movement in Merseyside from the mid-1980s and was Senior Researcher for Lifeline Publications & Research (Manchester, 2005–10). Lifeline literature on drugs, used in some schools, is hugely harm reduction based. Several leaflets and DVDs on “How to inject” are freely advertised on the Internet and can be easily accessed, as are needles, by children. Children are scared of injecting—now they needn’t worry!
  11. The last paragraph in Lifeline’s Big Blue Book of Cannabis says, “If we look at our crystal ball at the world of tomorrow what can we expect to see? More medical uses for cannabis; stronger types of weed appearing on the streets; more laws; more fiendish ways of catching users and the same old hysterical reactions to people smoking a plant”—That says it all!
  12. My analysis of the cannabis information in the “Summary of Health Harms of Drugs” pages 31–33 follows:
  13. “No cases of fatal overdose have been reported”. Isn’t it the same with tobacco? “No confirmed cases of human death”. “Stoned” drivers kill themselves/others. Cancers recorded, especially head and neck at young age (Donald 1993, Zang 1999). Serotonin, “happiness” neurotransmitter depleted (Gobbi 2009) causing depression—can lead to suicides (Fugelstad (Sweden) 1995). Violence from psychosis or during withdrawal, murders documented in the press and coroners’ reports. Teenagers have had strokes and died after bingeing (Geller 2004).
  14. Strength: No figures are given for Tetrahydrocannabinol (THC) content. Skunk now averages 16.2% but can range up to 46% THC, old herbal 1–2%, Hash 5.9% (Home Office Report 2008). No warning that skunk occupies 80% of the UK market, hash 20%. FRANK says that skunk is 2–4 times stronger than old herbal cannabis—wrong! They mislead the public by comparing it with hash. The enlightened Dutch, who know about drugs, have now banned any skunk with a THC content over 15%, equating it with cocaine and heroin. The vast bulk of our young users are smoking what amounts to a class “A” drug!
  15. 50% of THC will remain in cells for a week, 10% for a month. The John Moores report makes no mention of its persistence. Numerous studies show the adverse effects of this on academic results (Grade D student four times more likely to use cannabis than one with A grades, USA 2002) and personality. Users become inflexible, can’t plan their days, can’t find words or solve problems, development stalls, they remain childish. At the same time they feel lonely, miserable and misunderstood (Lundqvist 1995).
  16. Psychosis: Not reported is that anyone (with/without family history) taking cannabis can develop psychosis if they take enough THC (Morrison, Robin Murray team 2009). D’Souza (2007) had also shown this. Cannabis increases dopamine (pleasure neurotransmitter) in the brain. Excess dopamine is found in brains of schizophrenics. The first paper linking psychosis and cannabis was published in 1845! The report says: “Health effects of increases in the potency of cannabis products are not clear”. Skunk users have been found to be seven times more likely to develop psychosis than hash users ( Di Forte, Murray’s team 2009).
  17. No mention of absence of Cannabidiol (CBD) (anti-psychotic) in skunk, so psychotic THC is not counteracted! Old herbal cannabis had equal amounts CBD and THC. (McGuire 2008 and 2009, Morgan (2010), Demirakca (2011) etc. Dependence risks and psychotic symptoms are blamed on bingeing—regular use is enough! It is suggested that psychotic or schizophrenic patients may be self-medicating negative symptoms—disproved in several papers (Degenhardt 2007, Van Os 2005).
  18. They say that likelihood of progressing to other drugs is more to do with personality, lifestyle and accessibility than a gateway effect. Swedish research (Hurd 2006, Ellgren 2007) on animals finds THC primes the brain for use of others, and Fergusson (2006 and 2008) in a 25 year NZ study from birth found cannabis to be the single most significant factor for progressing.
  19. It is claimed that there is “no conclusive evidence that cannabis causes lung cancer” We don’t have conclusive proof for cigarettes and lung cancer! “Evidence for the effects on the immune system is limited”—over 60 references in my report! No warning that people should not drive within 24 hours of consumption (Leirer 1991).
  20. Children born to cannabis-using mothers may have “mild developmental problems”. Fried has followed child development since 1987. He has found cognitive impairment, behaviour and attention problems, babies twice as likely to use the drug at adolescence. Goldschmidt (2002) found delinquent behaviour, Bluhm (2006) warned of an increased risk of neuroblastoma, a childhood cancer.
  21. Now several recent papers demonstrate structural brain damage eg Welch (September 2011) loss of volume in thalamus, Solowij 2011 smaller cerebellum white matter volume, Ashtari (2011) loss in hippocampus volume, (Yucel 2008, Rais 2008).
  22. I have cited only a few references, there are well over 600 in my report.
  23. At least one piece of information in FRANK’s magic mushroom (Psilocybe—Liberty Caps) section is not in the Moore’s report, so where did it come from? The extremely poisonous familiar red/white spotted fungus, the Fly Agaric, is included. This is serious—it should not be there. Its inclusion is even more alarming as the amount used (1–5g) and the fact that it should not be eaten raw are given—blatant harm reduction advice! A child could die!
  24. New posters from FRANK:

www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/frank/coke-poster

www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/frank/meow-poster

www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/frank/skunk-poster

My pupils would have used words like: pathetic, patronising, trite, useless and positively encouraging drug use—and so would I.

  1. I repeat—children don’t want to take drugs. They want a sound education and good grades, free from hassle and the pressure to take drugs.
  2. Drugscope’s cannabis information updated 2011 is even less reliable than FRANK’s. They continue to deny that cannabis can cause physical addiction, say “There are suggestions that the drug can in rare cases trigger psychosis, a factor that led to the government in 2009 to reclassify cannabis” (Drugscope disagreed with the reclassification), state that the strength of skunk is 12–14% THC when in 2008 it averaged 16.2%, and completely ignore all the Swedish and New Zealand evidence for the “Gateway Theory”. Professor Murray’s 2009 papers are not mentioned, and in a reply to me, the writer of Drugscope’s literature, seemed to think it was the THC that caused cancers, not the smoke.
  3. In 2006, Professor David Nutt said that LSD and Ecstasy probably shouldn’t be class A. In May 2008 I attended an open meeting of the ACMD at which a presentation (by Pentag) on ecstasy was given—a meta-analysis commissioned by the ACMD. I was concerned about their conclusions so contacted the foremost ecstasy researcher in Britain, Professor Andrew Parrott of Swansea University.
  4. Incredibly Professor Parrott knew nothing about the proposed down-grading of ecstasy by the ACMD until I alerted him. He was leaving for Australia to Chair an International Conference on Ecstasy and sent me his numerous publications. I passed them to the ACMD. When he returned, having missed the evidence—gathering meeting in September, I alerted him to the open meeting in November. He had to send three e-mails before they answered and allowed his presentation to go ahead. He was given a mere 20 minutes.

In an open letter to the ACMD on November 13 he wrote:

  1. 29. I cannot believe that I have spent the past 14 years undertaking numerous scientific studies into Ecstasy/MDMA in humans, then for the ACMD to propose downgrading MDMA without a full and very detailed consideration of the extensive scientific evidence on its damaging effects. My research has been published in numerous top quality journals, and can be accessed via my Swansea University web-page.
  2. Professor Nutt, who was Chairing the ACMD meeting on November 25 2008 for the first time was severely criticized by Professor Parrott. He said that Nutt made numerous factual errors, eg that there were zero dangers from injection of MDMA. Parrott said it was probably safer to inject heroin. Nutt said that ecstasy was not addictive, involved no interpersonal violence, was not responsible for road deaths, did not cause liver cirrhosis or damage the heart. Scientific work demonstrates that users show compulsive and escalating use, midweek aggression, that driving under its influence is extremely dangerous, that it is hepatotoxic—liver transplants have been needed in young people under 30, and profound cardiovascular effects. Professor Nutt did not defend himself in our presence. Nor to my knowledge has he since!
  3. Answers from Anne Milton, Minister for Public Health given to Parliamentary Questions from Charles Walker MP, October 2011 include:
  4. The Medical Research Council (MRC), funded by The Department of Business, Innovation and Skills, is supporting Professor Glyn Lewis in his research on adolescence and psychosis and Professor Val Curran’s research into the vulnerability of people to the harmful effects of cannabis.
  5. Professor Lewis, widely quoted on the Web by Peter Reynolds (CLEAR—Cannabis Law Reform) said that, “there is no certainty of a causal relationship between cannabis use and psychosis”, and announced that the risk of psychosis from cannabis use is at worst 0.013% and perhaps as little as 0.0030%. Professor Curran is a member of Professor Nutt’s Independent Scientific Committee on Drugs (ISCD).
  6. I find it incredible that there is essential sound accurate up-to-date scientific information about the effects of cannabis available in scientific journals and publicised in the press and the public is not being made aware of it by FRANK, the official Government website. Why has FRANK not been taken to task?
  7. While the harm reduction lobby are being consulted, persisting with their own agendas, and the preventionists supporting the Government’s New Strategy not listened to, nothing will change.
  8. Prevention is better than cure. Prevention is what every parent wants for their children. Prevention is common sense and it works.
  9. Meanwhile, while we wait for common sense to prevail, some children will become psychotic, addicted, move on to other drugs, drop out of education or even die. And the parents I work with will be left picking up the pieces.

January 2012

Source: Home Affairs  or visit http://www.parliament.uk/business/committees/committees-a-z/commons-select/home-affairs-committee/publications/

By Grace Deng – Journalist, Washington State Standard –

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

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

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

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

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

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

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

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

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

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

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

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

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

What exactly is the Icelandic model?

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

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

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

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

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

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

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

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

The tribal model

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

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

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

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

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

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

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

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

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

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

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

Source: https://www.anacortesnow.com/news/health/5285-washington-tribes-look-to-iceland-for-help-getting-teens-off-drugs

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.

“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, 2019Helms, 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, 2023SAMHSA 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?”

 

Posted 

Being a father is not easy; it takes sacrifice, which means playing an essential role in a child’s life by being there for them and loving them unconditionally.

Every father knows they need to provide abundant love and support. A father is always there for their children, offering guidance, support, and education. The greatest joy, of course, for any father is seeing their children thrive, do well in life, and be healthy.

Yet things happen in life, and kids and teens experiment with risks while testing their limits and boundaries, such as trying drugs or alcohol. Fathers have a responsibility to speak to their kids about drugs and alcohol and help them understand the risks and consequences.

Fortunately, drug education and prevention campaigns have proven relatively effective in Illinois, but more should be done. According to drug abuse statistics, Teenagers in Illinois are 4.29% more likely to have used drugs in the last month than the average American teen. Roughly 8.69% of the 12 to 17-year-olds surveyed reported using drugs in the previous month, with marijuana being the most widely used substance.

Illegal drugs today are more readily available than ever before. According to the DEA, drug traffickers have turned smartphones into a one-stop shop to market, sell, buy, and deliver deadly fake prescription pills and other drugs. Amid this ever-changing age of social media influence, kids, teens, and young adults are easily influenced.

Drug traffickers advertise on social media platforms like Instagram, Snapchat, TikTok, Twitter, YouTube, and Facebook. The posts are promptly posted and removed with code words and emojis used to market and sell illicit drugs. Unfortunately, digital media provides an increased opportunity for both marketing and social transmission of risk products and behaviors.

Fathers are responsible for protecting and preparing our children for the world. Drug education is essential. Take the time to speak to your kids about the dangers of illicit substances, how to avoid and manage peer pressure, and what to look for. Be prepared to share personal experiences and help them understand that some choices have consequences.

Along with bearing this responsibility, fathers must not neglect their well-being and mental health. Raising children can be a lot; there are many challenges along the way, and the pressure of being a good influence can get the best of us. We may second guess our choices and decisions and stress over the small things.

All of this makes it vital not to ignore our mental health; children, especially younger kids, mimic what they see. How we cope with frustration, anger, sadness, or isolation impacts our children in several ways.

Our actions have consequences. Children see how we handle every situation, and while no father is perfect, we must be conscious of the fact they are impressionable when they are young. They look up to us, mimic our actions, and see when we are doing well in life mentally.

The key for fathers caring for children is to take the time to care for themselves. However, if you are struggling, contact 988 Suicide and Crisis Lifeline. Taking care of your mental health is the same as taking care of your physical health; it is an integral part of your well-being and contributes to you being the best father you can be.

Nickolaus Hayes is a healthcare professional in the field of substance use and addiction recovery and is part of the editorial team at DRS. His primary focus is spreading awareness by educating individuals on the topics surrounding substance use.

Source: https://rochellenews-leader.com/stories/every-father-should-speak-to-their-kids-about-drugs-and-alcohol,57623

Teens who use cannabis have a significantly higher risk of developing a psychotic disorder compared to those who don’t, according to a study published in the journal Psychological Medicine Wednesday, the latest research linking the drug to mental health disorders among young adults.  Other research has linked the drug to mental health disorders in young adults.

KEY FACTS

Teens aged 12 to 19 who used cannabis had an 11 times higher risk of developing a psychotic disorder compared to teens not using cannabis, according to an analysis of health data for 11,000 teens and young adults aged 12 to 24.

The study did not find an association between cannabis use and psychotic disorders in people aged 20 to 33.
The data—pulled from the annual Canadian Community Health Survey from 2009 to 2012—looked into hospitalizations, emergency room visits and outpatient visits, and researchers followed up with the participants for additional visits to the doctor, the emergency room or other hospitalizations in the nine years after the survey.

Among the teens who visited the emergency room or were hospitalized for psychotic disorders, about 5 in 6 reported using cannabis previously, researchers said.

Teens who use cannabis might be at a higher risk of developing psychotic disorders because the drug disrupts the endocannabinoid system, which helps regulate bodily functions like sleep or mood, resulting in symptoms like hallucinations, according to the study.

Though there is a strong yet age-dependent association between cannabis use and psychotic disorders, researchers noted it’s hard to say whether there is a direct link, as it’s possible the teens were self-medicating with cannabis to treat symptoms of psychotic disorders before they were clinically diagnosed.

BIG NUMBER

29%. That’s the percentage of high school seniors in the U.S. who reported using cannabis over the previous year, according to the annual Monitoring the Future Survey in 2023, which reports drug and alcohol use among adolescent students.

KEY BACKGROUND

Other studies in recent years have linked psychotic disorders in young adults to cannabis. In a study published last year, researchers found young men who used cannabis have an increased risk of developing schizophrenia compared to young women. A year earlier, researchers found there was “considerable evidence” linking cannabis use and depression among adolescents. The study also suggested the link was caused by a disruption of the endocannabinoid system. In 2018, researchers called for additional drug prevention programs targeting cannabis use in teens, after data indicated cannabis use could result in increased anxiety.

TANGENT

Last week, the Justice Department moved to reclassify marijuana—listed as a Schedule I drug like heroin, LSD and ecstasy—as a Schedule III drug under the federal Controlled Substances Act. The designation, if approved, recognizes marijuana as having potential medical benefits, which could allow for future studies on the drug’s potential benefits. The proposal still requires approval from the Drug Enforcement Administration.

Source: https://www.forbes.com/sites/tylerroush/2024/05/22/teens-using-cannabis-are-at-higher-risk-of-psychosis-study-suggests/

May 18, 2024

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

Revitalizing anti-corruption efforts

Supporting anti-corruption efforts in Hong Kong was a major focus during Ms. Waly’s mission. In a speech delivered at the 8th Symposium of the Independent Commission Against Corruption (ICAC) of Hong Kong on the occasion of the Commission’s 50th anniversary, Ms. Waly said that “In this era of uncertainty, as crises rage and threats simmer, we need to re-think and revitalize anti-corruption efforts,” adding that “corruption underpins many of the biggest challenges facing humanity today.”

In her remarks, Ms. Waly outlined four key priorities that UNODC considers essential to pave a new path for anti-corruption efforts, namely to 1) future-proof responses to corruption by leveraging the positive role of technology and unleashing the potential of youth; 2) unlock the full potential of international and regional anti-corruption frameworks, and to streamline cross border cooperation; 3) addressing gaps in capacities through partnerships; and 4) better understand corruption and its trends, through robust measurement, research, and analysis.

“Corruption is undermining everything we fight for, and empowering everything we fight against,” she said. “As we stand at this historic crossroads of challenges and opportunities, we need to seize every chance […] to innovate in the face of growing corruption challenges, together.”

On the sidelines of the Symposium, Ms. Waly signed a Memorandum of Understanding with ICAC Commissioner Woo Ying-ming to solidify their partnership and expand joint technical assistance to advance anti-corruption efforts in Asia.

Ms. Waly also met with the Chief Executive of Hong Kong, Mr. John KC Lee, to discuss the importance of coordinated regional action in the fight against organized crime.

Ms. Waly later visited the Hong Kong Jockey Club (HKJC) where she met its Executive Director of Racing and the Secretary General of the Asian Racing Federation (ARF).

Illegal betting in sports has become a global problem, helping to drive corruption and money-laundering in sports. By running the ARF and Anti-Illegal Betting and Related Financial Crime Council, HKJC is working to address issues like illegal betting and financial crimes that affect the integrity of sports and racing.

Ms. Waly invited the HKJC and ARF to support UNODC’s GlobE4Sport initiative, which will be launched this year. The initiative will create a global network which will support anti-corruption efforts in sport through the informal sharing of information between criminal justice authorities and sports organizations.

Ms. Waly also visited Hong Kong customs facilities, where she was briefed by Commissioner Louise Ho Pui-shan on the equipment and measures used by law enforcement to inspect cargo shipments and tackle trafficking in drugs and wildlife.

Supporting compassionate rehabilitation

With fewer than 20 per cent of people with drug use disorders in treatment globally, UNODC is committed to supporting non-stigmatizing and people-centred health and social services to people who use drugs, as reflected by Ms. Waly’s visit to the Association of Rehabilitation of Drug Abusers of Macau (ARTM).

ARTM is a civil society organization offering voluntary, evidence-based prevention, treatment and harm reduction services to affected communities in Macau, China. Civil society organizations (CSOs) play a vital role in tackling drug related issues, including by combating stigma and delivering essential services to affected communities.

During the visit, Ms. Waly met with people in rehabilitation for drug use and learned about the work of ARTM in providing new life skills, such as painting, baking and ceramics classes, as well as treatment for women and classes for children.

ARTM was itself founded by a former user of drugs, Augusto Nogueira, whose experience helps the organization provide compassionate and inclusive rehabilitation. Augusto says that his main struggle when he was using drugs was not being able to identify a solution for his problem.

“My addiction was stronger than my will to stop using,” he said.

After undergoing his own challenging rehabilitation process, Augusto had ideas on how to professionalize the existing prevention and treatment activities in Macau. With the goal of providing evidence-based, personalized approaches to drug treatment and rehabilitation services, he founded ARTM in 2000.

ARTM belongs to the Asia-Pacific Civil Society Working Group on Drugs, supported by UNODC. Convened by the Vienna NGO Committee on Drugs (VNGOC), the Working Group aims to strengthen civil society action on drug related matters and the implementation of joint international commitments in the Asia-Pacific region.

ARTM also works to bring the voices of civil society to the international stage, including by presenting civil society recommendations on how best to implement drug policies at the Commission on Narcotic Drugs.

During her visit, Ms. Waly acknowledged the call from grassroot civil society organizations like ARTM for greater investment in evidence-based prevention, including through the implementation of the CHAMPS initiative. Ms. Waly praised ARTM’s cooperation with UNODC, including by delivering a training workshop on UNODC’s family-based prevention programme, Strong Families.

Ms. Waly also met with the Secretary of Security of Macau to discuss how Macau’s experience can help inform regional responses in tackling organized crime, illegal online gambling, and drug trafficking.

Source: https://www.unodc.org/unodc/en/frontpage/2024/May/unodc-executive-director-highlights-anti-corruption–fight-against-organized-crime–and-drug-prevention-on-visit-to-hong-kong-and-macau–china.html

 

 

 

 

April 24, 2024

 

Introductory remarks (shown in italic) added by NDPA (UK) on 19 May 2024:

 

The presentation below is from notable Australian specialists in the field of drug prevention, submitted to the Australian Government. The essence of the presentation is that: “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.”

 

Although this presentation is addressed to the Australian Government,  Drug Free Australia strongly feel that this information should inform and guide governments worldwide.

 

<<<<<<<<<<<<<<<<<<<<<DFA>>>>>>>>>>>>>>>>>>>>>>

 

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.

 

  1. 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.

 

  1. 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.

 

Herschel Baker

International Liaison Director,

Queensland Director

Drug Free Australia

M: 0412988835 

Prevent. Don’t Promote Drug Use

drugfreeaust@drugfree.org.au

drugfree@org.au

Joy Butler

President

WCTU

http://www.dfk.com.au/index.html

 

Links to view the articles related to the above presentation:

First click on the link, then click on the image that appears

 

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

 SUMMARY

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

KEY TAKEAWAYS

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

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

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

 

Source: https://www.heritage.org/crime-and-justice/report/twenty-first-century-illicit-drugs-and-their-discontents-the-challenges

 

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

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

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

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

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

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

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

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

Among the findings:

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

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

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

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

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

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

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

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

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

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

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

How Linn County brings an evidence-based program into classrooms

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

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

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

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

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

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

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

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

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

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

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

State’s fentanyl awareness curricula effort limited, experts say

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

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

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

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

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

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

Teens say schools should step it up

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

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

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

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

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

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

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

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

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

“And they’re legal,” said Garcia.

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

What classroom prevention looks like

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Source: https://www.opb.org/article/2024/01/16/investigation-most-oregon-drug-use-prevention-programs-for-kids-not-science-backed/

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

by
JANUARY 16, 2024

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

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

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

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

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

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

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

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

Other states put science at the center of prevention

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

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

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

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

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

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

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

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

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

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

State could spread promising approaches

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

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

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

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

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

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

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

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

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

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

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

Where Oregon stands

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

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

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

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

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


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

Source: https://www.thelundreport.org/content/other-states-drive-youth-prevention-ways-oregon-does-not

 

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

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

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

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

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

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

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

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

Cannabis a public health concern

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source: https://health.ucdavis.edu/news/headlines/teens-use-cannabis-for-coping-enjoyment/2023/12

Navigating the Adolescent Overdose Crisis: Insights and Prevention Strategies

An Alarming Rise in Adolescent Drug-Related Mortality

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

The Overdose Crisis among U.S. Adolescents

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

Addressing the Crisis: Naloxone in Schools

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

The Role of Education and Awareness

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

The Take-Home Naloxone Program: A Potential Lifesaver

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

Conclusion

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

 

Source: https://medriva.com/addictions/navigating-the-adolescent-overdose-crisis-insights-and-prevention-strategies/

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

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

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

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

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

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

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

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

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

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

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

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

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

Opportunities for drug treatment and prevention

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

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

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

International cooperation essential to tackle this growing trend

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

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

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

Persistent disparities in access to medicines for the treatment of pain

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

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

Notable developments in illicit drug supply

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

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

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

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

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

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

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

Precursors report

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

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

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

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

***

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

 

Source: https://unis.unvienna.org/unis/en/pressrels/2024/unisnar1481.html

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

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

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

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

 

Source: https://lexingtonky.news/2024/02/24/opioid-epidemic-is-in-a-fourth-wave-with-multiple-substances-being-used-at-the-same-time-and-fentanyl-is-the-most-common/

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

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

Why Relapse Occurs During Drug Abuse Recovery

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

Mental Health Issues Combined With Substance Addiction

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

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

Poor Coping Skills

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

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

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

Uncomfortable Withdrawal Symptoms During Detox

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

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

Lack of Healthy Boundaries

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

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

The Stages of A Relapse

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

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

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

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

Emotional Relapse Stage

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

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

Mental Relapse Stage

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

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

Physical Relapse Stage

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

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

What To Do If You Relapse

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

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

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

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

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

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

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

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

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

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

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

How to Prevent Relapse After Drug Addiction Treatment

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

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

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

Compose a Relapse Prevention Plan

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

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

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

Build a Supportive, Nurturing Environment

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

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

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

Maintain a Positive Mindset

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

Make Your Self Care a Priority

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

Why Do People Relapse During the Recovery Process?

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

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

Source:  https://www.hippocraticpost.com/addiction/understanding-and-overcoming-substance-abuse-relapse/

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

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

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

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

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

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

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

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

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

Prevention sometimes takes a backseat

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

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

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

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

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

Then, comes the messenger.

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

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

Limited resources stand in the way

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

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

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

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

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

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

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

Experts say peer mentorship is a promising approach.

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

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

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

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

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

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

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

Source:  https://www.wbaa.org/health-and-science/2024-03-13/school-substance-use-prevention-efforts-are-crucial-the-question-is-how-to-do-it

 

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

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

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

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

For the full contents, please go to: 

Source: https://babel.hathitrust.org/cgi/pt?id=ien.35557000188076&seq=11 This version September 2023

Abstract and Figures

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

Source: https://www.researchgate.net/publication/330347576_Perspective_Iceland_Succeeds_at_Preventing_Teenage_Substance_Use February 2019

US DRUG CZAR EXPLAINS CAUSES AND RSDT TOOL TO PREVENT TEEN DRUG USE AND OVERDOSE DEATH INTERVIEW WITH U.S. DRUG CZAR JOHN WALTERS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So remember that, when you find your child using and they want to lie to you up down and sideways saying, “It’s the first time I’ve ev