Critics Say Washington AA Chapter Is Cultlike

A troubling story about an AA group that's gone off the rails. Over the years I've seen groups like this pop up from time to time. Fortunately, they tend to be self-limiting. They usually grow for a short time and then fizzle out as people either leave or relapse. It's troubling that this group seems to have gotten very large and lasted for some time.

Help Comes In The Mail For Drinkers

At Dawn Farm, we tend to see one end the continuum substance use disorders. It's helpful to keep in mind that this isn't the whole picture. It appears that education by mail may be an effective way to get some low hanging fruit at the other end of the continuum.

Drugs may cause addiction by 'remodelling' brain

New evidence that addiction may be the result of hijacked neurobiological learning mechanisms:

...In experiments carried out on rats, a team of American researchers at Brown University in Rhode Island showed that even a single dose of morphine physically altered the neural pathways that regulate the sensation of craving.

The change persisted long after the effects of the drug had worn off.

The study, published in the British journal Nature, adds weight to a new theory that sees addiction as a disease which "remodels" brain mechanisms related to learning and memory, the lead author, cellular physiologist Julie Kauer, said in an interview.

...

Kauer's experiments focused on the activity of synapses, the connective junction between brain cells.

So-called excitatory synapses increase the flow of chemicals -- such as dopamine, associated with a feeling of euphoria -- while inhibitory synapses impede such flows.

"You have to have both, because they create checks and balances on the system," she explained.

Previous studies have shown that excitatory synapses are strongly linked to building one's capacity for memory, and that -- just like muscles in the body -- they grow stronger over time with increased activity.

This is a virtuous circle when it comes to learning because the release of small amounts of dopamine creates the incentive to learn more. It also helps hone basic survival instincts.

But the same mechanism becomes a dangerous magnet for abuse when certain drugs such as heroin and cocaine provoke a similar response.

"If you have ever been really, really thirsty, that same craving may be the same thing that is going on in the brain of someone who is addicted to a drug," Kauer said.

In this context, she added, "addiction is a form of pathological learning" in which the brain has created a rewards system for something that is harmful to the body.

...

The Nature study breaks new ground in two areas. It presents the strongest evidence to date that inhibitory synapses are also capable of "long-term potentiation", or LTP, the ability to strengthen and change over time.

And it showed that morphine, an opiate, continued to block LTP long after the drug was absent from the animal's system.

"The fact that they are long lasting could be one of the reasons that the craving for drugs is so hard to conquer, and suggests that addictive drugs are producing persistent physical changes," she said.

The study also points to the intriguing possibility of a pharmaceutical treatment to neutralize intense cravings, which could help those fighting addiction to resist the temptation of relapse.

It could likewise help prevent unwanted side effects of morphine in hospitals, where the opiate is frequently used as a painkiller.

Heavy cannabis use by teens is more dangerous than alcohol

I think that it's safe to assume that this study will prompt more research on the comparative effects of alcohol and pot. Let this new battle in research wars begin!

People who start using cannabis as teenagers are more likely than drinkers to suffer from mental illness, have relationship problems, and fail to get decent qualifications or jobs, according to a new study by academics.

'Cannabis really does look like the drug of choice for life's future losers,' says Professor George Patton, who conducted the 10-year study that followed the fortunes of 1,900 schoolchildren until they were 25. 'It's the young people who were using cannabis in their teens who were doing really badly in terms of their mental health. They were also less likely to be working, have qualifications or be in a relationship and more likely to be taking other drugs.'

The 10-year study is the first of its kind to compare drinkers with cannabis users. Almost two-thirds of people had tried cannabis before they turned 18.

Heavy users of the drug were between three and six times more likely to use other drugs, compared with drinkers, less likely to be in a stable relationship and up to three times more likely than drinkers to have dropped out of education or be unemployed.

Desperate measures

I don't know what to say about this story. I'm a little skeptical that she presents herself as a mild-mannered professional mother whose maternal instincts drive her to routinely purchase heroin for her son and then write about it for Black Poppy magazine.

Here are letters to the editor about the article.

Comparative Analysis of Alcohol Control Policies in 30 Countries

This study finds a relationship between alcohol consumption and alcohol policy. I was suprised to see the U.S. rated as more permissive than Canada, but it looks like it's primarily due to the absence of price controls or federal taxes and differences in drunk driving laws.

One journalist's trip through the culture of medical pot clubs to a pain-free life

This article offers a sense of how California's medical marjuana law works.

Decreased respiratory symptoms in cannabis users who vaporize

Here's a research foundation for a new and exciting harm reduction intervention:

Abstract: Cannabis smoking can create respiratory problems. Vaporizers heat cannabis to release active cannabinoids, but remain cool enough to avoid the smoke and toxins associated with combustion. Vaporized cannabis should create fewer respiratory symptoms than smoked cannabis. We examined self-reported respiratory symptoms in participants who ranged in cigarette and cannabis use. Data from a large Internet sample revealed that the use of a vaporizer predicted fewer respiratory symptoms even when age, sex, cigarette smoking, and amount of cannabis used were taken into account. Age, sex, cigarettes, and amount of cannabis also had significant effects. The number of cigarettes smoked and amount of cannabis used interacted to create worse respiratory problems. A significant interaction revealed that the impact of a vaporizer was larger as the amount of cannabis used increased. These data suggest that the safety of cannabis can increase with the use of a vaporizer. Regular users of joints, blunts, pipes, and water pipes might decrease respiratory symptoms by switching to a vaporizer.

Claims injecting room a failure 'offensive'

A fight is brewing in Australia over the effectiveness of an supervised injection site:

NSW Opposition Leader Barry O'Farrell said today he would vote to close down the injecting room in Kings Cross because it was not helping addicts get into rehabilitation.

His comments follow revelations that 211 referrals to detox and rehabilitation services had resulted from 20,783 visits to the centre in the three months to October 2006.

Ingrid Van Beek, director of the Medically Supervised Injecting Centre (MSIC), said the number of visitors rather than the number of visits was relevant to debate about the centre's referrals.

She said it was "offensive" to the staff at the centre to imply they would not attempt to refer addicts to rehabilitation programs.

"We have 230 visits a day among drug users who would be otherwise be injecting in back streets, unsupervised, less safe situations," Dr Van Beek said.

"It's much more appropriate for us to be looking at what percentage of people that we see have been referred to treatment."

Dr Van Beek said that in six years, the MSIC had made contact with 10,000 drug users and more than 1000 of them had received referrals for rehabilitation.

Another 11 per cent had been referred to medical treatment, with some going on to receive rehabilitation, she said.

Even her numbers seem pretty difficult to crow about. If it's not an issue of philosophy, maybe they're just not vary good at motivating addicts to change?

Sober housing in the news

Connecticut is looking at creating licensing standards in response to problems with poor supervision and zoning violations:

Legislation was introduced this year that would have required the state to implement a licensing plan for sober houses. Faced with that possibility, it is no coincidence that state mental health officials announced this past week that they will begin monitoring sober houses more closely and have started a certification program for them.

This also caught my attention:

The state provides rental subsidies for residents who, having completed rehabilitation programs for substance abuse, need the safe harbor of a sober environment to continue their recovery.

There have also been concerns about houses in California. Here's an interview with an official from the state's licensing body.

New credential for co-occurring disorders will pressure addiction professionals

New credential for co-occurring disorders will pressure addiction professionals:

...a new credential, represented by the initials CCDP (Certified Co-Occurring Disorders Professional) was introduced last week by the International Certification & Reciprocity Consortium/Alcohol and Other Drug Abuse (IC&RC) in a move that pressures the addiction treatment workforce to get more training, according to a report.

This new certification is meant to treat patients with both mental and substance use, or co-occurring disorders. These patients have historically been given conflicting advice or been told to get one treatment first over the other. The new credential will make it possible for addiction professionals to show they have the ability to treat co-occurring disorders.

In the brewing controversy about who will treat people with co-occurring substance use and mental health disorders – addiction or mental health professionals – turf, jobs, and millions of funding dollars are at stake. Not all addicts have co-occurring mental disorders, but as many as 80 percent do. Those people need specialized treatment that integrates best practices for treating both disorders at the same time, according to experts in the field. If people with co-occurring disorders are shuttled from program to program, neither condition will be treated successfully, studies have shown.

The new credential paves the way for a change in the treatment system, which has always had federal and state-level systemic barriers to integration of addiction and mental health treatment, according to Dalphonse. "The practitioner who will survive is the one who can deal with the interactive relationship of these two disorders," he said.

Baking Soda Ban Suggested to Control Crack

From the Goofy Overreactions department...

A Companion to Protect Addicts From Themselves

The New York Times has a story on high-end recovery coaches. Recovery coaching has been around for a while and can be an effective service to promote treatment readiness and support recovery once it's begun. This article doesn't exactly paint an inspiring picture. Obviously, there are potential excesses and abuses. Hopefully, users of these services will be discriminating consumers.

Drug use rearrests up after Prop. 36

Drug use rearrests up after Prop. 36 - Los Angeles Times

Convicted drug users in California are more likely to be arrested on new drug charges since Proposition 36 took effect than before voters approved the landmark law mandating drug treatment rather than incarceration, according a long-awaited study released Friday.

The state-funded study, conducted by UCLA researchers who have pored over four years of drug-related court cases, raises new questions about the effectiveness of Proposition 36 at a time when lawmakers and courts are discussing stricter requirements for defendants.

UCLA researchers tracking drug offenders found high levels of new drug arrests among those eligible in the first year of Proposition 36, which took effect in 2001. About 50% of those offenders were picked up by police within 30 months, compared with 38% of similar offenders convicted before Proposition 36.

The report notes that some increases in arrests were expected because Proposition 36 left offenders on the street who would have previously served time.

But the research also underscores the difficulty the state has experienced in getting drug offenders into treatment and out of trouble.

Only about 25% of the defendants who are sentenced to drug treatment complete the programs. And data released Friday show that even among those who complete drug treatment, more than four in 10 had new drug arrests within 30 months of their Proposition 36 convictions.

The numbers are worse for those who don't finish drug treatment. Researchers were surprised to find that those who failed to show up for rehab were less likely to be rearrested than those who went to some treatment but dropped out: 55% compared with 60%.

Supporters of Proposition 36 said the report shows how hard it is to treat a chronic disease like drug addiction but argue that the obvious conclusion is that more intensive treatment services are needed.

...

The UCLA study offered several recommendations for improving Proposition 36, options researchers said should be bundled together to improve results:

• Place more drug defendants in long-term treatment programs, including inpatient care, at an estimated cost of $19 million a year.

• Provide at least 90 days of treatment to all offenders, at a cost of $18 million a year. The length of treatment now varies widely, with many receiving far less than 90 days.

• Provide higher levels of narcotic replacement therapy for opiate users, at an annual cost of at least $3.7 million.

• Significantly increase community supervision — particularly for offenders who enter Proposition 36 probation with multiple previous convictions — at an annual cost of about $25 million.

It 's disappointing to hear these outcomes, but it isn't surprising if the compliance monitoring is weak and treatment is often less than 90 days. Research has found that treatment needs to last at least 90 days to be effective.

Parity for Effective Addiction and Mental Health Care: Not Just Treatment as Usual

Maia Szalavitz has written a follow-up post on parity. She "educates" by offering what she acknowledges "are extreme examples". She's indisputably correct that there is a history of over-diagnosis and over-treatment of addiction. We (Dawn Farm) have talked about this frequently. Addiction treatment providers have been far too quick to blame managed care for their demise and fail to take responsibility for these excesses and for failing to measure outcomes.

However, she's painting a pretty unbalanced picture. (At least she's not recycling that 10.5% statistic. ;-) I have several gripes but I'll limit myself to two. First, some historical context might be helpful. The period she'd reporting on was a characterized by excesses in many areas of health care. Consider the reductions in hospital stays for all conditions and procedures. Consider the reductions in the numbers of hysterectomies and C-sections. How about the changes in prescribing practices with antibiotics. These excesses are what set the stage for managed care. This was not unique to mental health or addiction treatment.

Second, as I pointed out earlier this week, her concerns about those excesses being recreated if parity is passed are unfounded. Where parity has been enacted, insurance companies have implemented tight managed care protocols to limit costs. Parity or no parity, the days of extended hospitalizations payed for by insurance companies are gone.

If anything, I think it's likely that parity could starve the kinds of programs she's rightly concerned about. (Although, I must admit that, in 13 years of practice and thousands of clients, I don't think I've ever met a client who was in the kind of boot camp she writes about.) I suspect that people send their kids to boot camps and programs like them at their own cost because their insurance company does not provide adequate care and hospital-based psych units are far too expensive. Parity might create circumstances where parents aren't so desperate for help (any help) that they send their kids to these programs.

Methadone: The Cure for Opiate Addiction?

I'm not sure what to make of this. I'll pass it along without further comment.

Study says genes affect ability to quit smoking

A very interesting study with more evidence that memory circuits are going to be a hot area of research in the coming years:

Researchers collected blood samples from 134 smokers intending to quit.

Six weeks later, they compared the DNA of those who had actually stopped with that of those who had failed, and discovered 221 gene variants present only in those who had successfully stopped.

'We can now calculate a genetic liability score for a smoker and tailor treatment based on the level of difficulty they will have in quitting,' said Jed Rose, director of Duke's Center for Nicotine and Smoking Cessation Research.

Rose described the study as the first to examine the impact of genetic markers on a smoker's ability to quit.

Of the 221 genes identified in the study, at least 30 have been linked to dependence on nicotine and other addictive drugs, Rose said.

'We now have further evidence that there is a biological basis not only for an addiction, but for a smoker's ability to successfully beat the addiction,' George Uhl, a neuroscientist at the National Institute on Drug Abuse, said in a press release.

In addition to discovering a link between genes and tobacco addiction, the scientists also discovered a link connecting certain genes with memory and habit formation processes-which could also contribute to addiction, Uhl said.

Wonder drug for smokers?

The Detroit News printed an article about Chantix today.

When the Cure Is Not Worth the Cost

Maia Szalavitz weighs in against parity in today's NYT.

On its face, providing equal coverage for mental and physical illnesses sounds like a good idea, something only a managed-care bean counter could oppose....Unfortunately, this change would not be as benign as it appears. Unless mental health parity is tied to evidence-based treatment and positive outcomes, generous benefits may become a profit bonanza for providers that does little to help patients.

Thanks to research by the National Institutes of Health and academic scientists during the last three decades, we now have proven treatments for depression, addiction and other mental disorders. But all too often clinicians do not use them.

...

Without financial incentives to provide treatments that are known to work, many mental health professionals stick with what they know, or pick up on the latest fad, or even introduce their own untested innovations — which in turn are spread by testimonials and credulous news media coverage.

According to a review by the Institute of Medicine in 2006, only 10.5 percent of alcoholics received “care consistent with scientific knowledge” of the disorder; similarly, 43 percent of children in psychiatric hospitals are given antipsychotic medication despite not suffering from psychosis. Tough boot camps for troubled teenagers — which have been proven to be ineffective and potentially harmful — thrive, while “multisystemic family therapy,” which effectively treats teenagers at home, is available only through the juvenile justice system.

Hmmm, where to begin? Let's start with "generous benefits may become a profit bonanza." While we still need to pass federal parity laws, we have a lot of experience with parity in this country. Some states have passed sweeping parity laws, some large employers have implemented it and federal employees have had parity since the 1990s. I haven't seen any studies of provider profit, but there is a lot of research on increases in spending following the implementation of parity. The impact on spending for mental health and substance abuse services ranges from a 9% decrease in spending to a 4% increase in spending. Current estimates of increases from the Wellstone Mental Health and Addiction Equity Acts hover around 1%. Hardly a bonanza. The truth is, when parity is implemented, managed care practices are implemented to limit costs.

As for use of evidence based practices, I went to the Institute of Medicine review she mentioned. The quote she pulled was from a New England Journal of Medicine article reporting on a RAND study. The study based its ratings on compliance with quality indicators. There were 5 quality indicators for alcohol dependence and only 2 were offered as examples: "Assessment of alcohol dependence among regular or binge drinkers" and "Treatment referral for persons given a diagnosis of alcohol dependence". The problem with both was "underuse."

I was unable to find the other 3 indicators, but this paints a different picture than the NYT Op-Ed suggests. First, these indicators seem to assess primary care providers, not specialty treatment providers. Second, one could argue that the compliance problem with both of these indicators might be caused or worsened by the absence of parity. Local primary care physicians often don't assess and make referrals because adequate care is out of reach for many of their patients.

Finally, offering the TV show "Intervention", forcing patients to identify as alcoholics, and teen boot camps as examples of modern treatment is a bad faith argument. It's a little like characterizing journalists by talking about Stephen Glass, Jayson Blair and Jack Kelley.

The interventionists I know describe "Intervention" as hopelessly old school and dated, which makes for much more entertaining TV. No treatment program I know of in our area "force[s] [patients] to identify themselves as alcoholics." In fact all heavily rely on Twelve Step Facilitation, Motivational Enhancement Therapy, and Cognitive Behavioral Therapy--all evidence-based practices. Finally, I don't know of any treatment provider or social worker referring a child to a boot camp.

One more thing. While treatment could undoubtedly be improved with greater emphasis on demonstrating outcomes or utilizing evidence-based practices (I won't get into the politics of evidence-based practices.), we know that treatment, even "treatment as usual", helps people and is cost-effective.

America's Forgotten War

NPR recently ran a series entitled America's Forgotten War. It includes a brief historical overview of the war on drugs and some interviews with players and people affected by drugs.

Expert: Risky teen behavior is all in the brain

This has something to make everyone mad. It challenges the value of prevention programs and questions the neurobiological capacity of kids to evaluate risk. This expert's solution is to exercise greater control over kids.

A new review of adolescent brain research suggests that society is wasting billions of dollars on education and intervention programs to dissuade teens from dangerous activities, because their immature brains are not yet capable of avoiding risky behaviors.

The analysis, by Temple University psychologist Laurence Steinberg, says stricter laws and policies limiting their behaviors would be more effective than education programs.

"We need to rethink our whole approach to preventing teen risk," says Steinberg, whose review of a decade of research is in the April issue of Current Directions in Psychological Science. It's published by the Association for Psychological Science.

"Adolescents are at an age where they do not have full capacity to control themselves," he says. "As adults, we need to do some of the controlling."

Neurological researchers around the country, spearheaded by Jay Giedd of the National Institute of Mental Health, have in recent years found that the brain is not fully developed until after 18. The brain system that regulates logic and reasoning develops before the area that regulates impulse and emotions, the researchers say.

Studies by Steinberg and others have found that the mere physical presence of peers increased the likelihood of teens taking risks.

Now he's using brain imaging to better understand why teens are so susceptible to peer pressure. He has just begun pilot projects to study brain activity in teens when doing various tasks with their peers, compared with adults under similar circumstances.

Steinberg believes raising the driving age, increasing the price of cigarettes and more strongly enforcing underage drinking laws are among ways to really curb risky behavior.

"I don't believe the problem behind teen risky behavior is a lack of knowledge. The programs do a good job in teaching kids the facts," he says. "Education alone doesn't work. It doesn't seem to affect their behavior."

Michael Bradley, a Philadelphia-area psychologist and author specializing in teenagers, says U.S. culture tends to view teens as small adults when, neurologically, they are large children.

"Kids will sign drug pledges. They really mean that, but when they get in a park on a Friday night with their friends, that pledge is nowhere to be found in their brain structure. They're missing the neurologic brakes that adults have."

Bradley also is worried about the future now that risky behaviors have trickled to the preteen set.

"People look at risk statistics, and they're more or less steady. It looks like things aren't getting that bad. But risk behaviors have been ratcheted down to younger and younger ages," he says. "What the parents may have dealt with at ages 16 and 17, the kids are dealing with at 11, 12 and 13 — at the time when their brains are least able to handle complex decisions about risk behaviors."

Such policy talk — even from psychologists — sparks a useful conversation, says Isabel Sawhill, co-director of the Center on Children and Families at the Washington-based Brookings Institution.

"It is good research for policymakers to consider, but we shouldn't infer from this research that all our past efforts have been ineffective," she says. "I'm not in favor of just doing education, but I'm also not in favor of not doing it, either. We need to do some of both."

Experts such as Sawhill and Caterina Roman, a senior research associate at the Washington-based Urban Institute, say some educational programs do work. But the widely popular Drug Abuse Resistance Education program known as DARE, launched in the 1980s, was determined to be ineffective.

Roman believes that recent findings that the teen brain is not yet fully developed will spawn some of the restrictions Steinberg recommends.

"Ten years from now, the driving age will be higher than it is now. The price of cigarettes will increase," she predicts.

Steinberg says he's not advocating a police state. But he says parents must help their children make wise decisions.

"We've given them too much freedom," he says. "We don't monitor and supervise them carefully enough."

Violence linked to price of beer

Economists examine the relationship between the price of beer and violence:

A research report published in Applied Economics has found that the number of patients with violence-related injuries treated in hospital emergency rooms is related to the price of beer.

...

The researchers examined admissions to 58 hospital accident and emergency departments over a five year period and found that as the price of beer increased, violence-related injuries decreased.

In general, studies have found that alcohol consumption increases both the risk of being a victim of violence and the perpetrator of it.

There are three main theories on why alcohol and violence are linked: i) due to the drug effects on the brain; ii) because people use alcohol as an excuse for violent behaviour; iii) because people who use alcohol might be more likely to be violent, perhaps due to personality factors like sensation-seeking, impulsivity or risk-taking.

Of course, these theories are not in competition and all the factors are likely to have some influence, but researchers are keen to find out how they interact to better understand the problem.

Interestingly, the Applied Economics study also looked at a number of other factors linked to violence and found that increases in poverty, unemployment, diversity of ethnic population, the summer months and major sporting events also independently predicted an increase in violence.

This combination of an economic and psychological approach to understand violence is particularly important for designing and implementing government or health service policies.

California drug treatment mandate must have proper support

Check out this editorial on Prop 36 in California. It provides some updates on the status of it and some background on how it works.

Kids Dying From Drugs And Alcohol: It's All About Supply And Demand

Kids Dying From Drugs And Alcohol: It's All About Supply And Demand:

A third of deaths among young people in developed countries such as Canada are caused by alcohol and illicit drugs....

“The drug that’s killing the greatest amount of young people globally is alcohol—nearly 90 per cent of substance-related deaths in developed countries such as Canada are due to alcohol,” says Stockwell. “A substantial dent could be made in these figures by combining regulatory, early-intervention and harm reduction approaches.”

Stockwell says regulating the price and physical availability of alcohol and tobacco is known to be highly effective. “These lessons could also be applied to the management of some other widely-used drugs such as cannabis,” he says. A previous CARBC study * showed cannabis is “very easy” to obtain in British Columbia and its use is more widespread among BC residents than the rest of Canadians.

Stockwell says another strategy is to reduce the demand for drugs by supporting young people and families at key stages in their development from before birth to teenage years. This includes educating parents on the dangers of using illicit substances during pregnancy and the risks associated with childhood exposure to second-hand smoke.

Harm reduction is another approach Stockwell highlights. Strategies such as random breath testing and graduated driver licensing have reduced the amount of driving-related deaths and injuries.

Barry R. McCaffrey: Methadone clinics are proven recovery tool for addicts

Barry McCaffrey weighs in on methadone in an opinion piece in a West Virginia paper. To his credit, he acknowledges being a board member of CRC Health Group, a for-profit corporation that claims to be the largest behavioral health care provider in the U.S. with more than $270 million in revenue last year and reported assets of $1.2 billion. They provide outpatient, residential and are a major methadone provider. It's also worth acknowledging that McCaffrey has been a methadone advocate for a long time.

Now to the substance. The column was written in response to community concerns about a clinic in the state. (CRC Health Group owns 7 of the 8 methadone programs in WV.) I don't have a problem with methadone being available to addicts who choose it, but I am troubled by the persistent myth that opiate addicts can't recover with drug-free treatment. We don't use methadone for opiate addicted health professionals. We use long-term treatment with intensive long-term monitoring and recovery support, and the outcomes are astonishing. Methadone is fine as one item on a comprehensive menu for clients to choose from, but I'm troubled by efforts to make methadone maintenance the default treatment. My experience in southeastern Michigan is that the complaints in the article above are credible.

This Week on Drugs

Here are some of the more absurd entries in The Stranger's This Week on Drugs:

Bad Medicine: DEA inaugurates 2005 meth law by busting man who bought seven boxes of Bronkaid.

Rough Rider: Woman gets DUI riding a horse.

Smooth Rider: Zamboni driver skates by DUI on thin ice.

Dairy Vows: Quit smoking.

Buds Bunny: Stuffed.

Interest Party: Guy nailed after applying for loan to buy crack.

Keith Richards: Not snorting family lines after all.

Law quells fear of aiding overdose victims : Local Politics : Albuquerque Tribune

After recently passing medical marijuana legislation, New Mexico passes a law providing partial immunity to people calling 911 for overdoses:

New Mexico has a new law aimed at encouraging those who overdose on drugs - and their friends, family or fellow partygoers - to call 911.

The measure, signed into law this week by Gov. Bill Richardson, provides limited immunity from prosecution for people who seek medical help for overdoses.

New Mexico is the first state to pass such a law, according to the National Conference of State Legislatures.

Tobacco as a model for illegal drugs

Two opinions that we should look to tobacco policy as a model for drug policy.

The first is from the Victoria Times Colonist:

We could have made tobacco illegal 20 years ago. But we chose a different approach -- managed use, with education and financial penalties to decrease smoking. And it's worked quite well.

So why not try the same approach with illicit drugs, or at least some of them? What if we say heroin and cocaine are like tobacco -- things we really wish people wouldn't use, but that we still accept some probably will.

Under that approach we would commit a lot of resources to making sure people didn't start, as we did with smoking. We'd target kids, but also vulnerable adults.

We'd make a big effort to help people quit, something we don't do today. And for people who wanted to keep using, we would prescribe heroin or cocaine or working substitutes. (The current half-hearted, restrictive methadone program really doesn't count.)

What are the downsides? It simply seems wrong to provide a drug like cocaine to people, for one thing. You could argue that others -- young people -- might see the practice as condoning drug use. (Though we've managed to allow controlled sale of tobacco products while condemning their use.)

Against those negatives, look at what we would gain. The people being prescribed the drugs wouldn't be stealing to get the money to buy them. Figure a 75-per-cent drop in property crime, conservatively, since Victoria police estimate up to 90 per cent of break-ins and thefts are drug-related. Police would be free to work on other problems and jails would be less crowded.

Organized criminals would lose a huge market. There would still be demand, but not enough to make the business attractive. Instead of spending their days and nights scrambling for money and drugs, users would have time to think about work and developing more stable lives.

Based on similar efforts in other countries, a significant number would seek treatment.

During a prescribed heroin trial in Switzerland, not only did crime by users plummet but about seven per cent quit during their time in the program.

Since people wouldn't be using drugs in alleys and dodgy settings, we'd save a fortune in health costs. Fewer overdoses, abscesses and infections. People with both mental health problems and addictions would get a chance to reduce the chaos in their lives and deal with their mental illness.

And all the while we'd be pushing for the same shift in attitudes toward drugs as we have achieved on smoking. It should be much easier. About 55 per cent of adults smoked in 1965, compared with 15 per cent in B.C. today. Only about two per cent of Canadians are heroin and cocaine users; if we can make the same relative gains, using the lessons from smoking, the number of addicts would be tiny.

That seems like a long list of benefits, with few costs. Yet instead, we push on with tactics and strategies that have failed to deal with prohibited substances for almost a century. We fight to reduce supply, unsuccessfully, and create crime and chaos and costs.

For whatever reason, we tried something different with tobacco. Maybe the big companies had too much clout, or there were just too many smokers. We didn't ban cigarettes or arrest people. We worked on reducing demand. And it worked.

Why not for other drugs?

I have a few reactions. First, I don't think his arguments are without any merit. As some states and other countries experiment with decriminalization, it will be worth watching which harms are reduced, which harms increase and what strategies are most effective in mitigating the undesirable effects of decriminalization. I've said several times in this blog that there is no such thing as a problem free drug policy. All of them will have problems associated with them, the question is this -- which problems are we willing to live with?

Second, I have concerns about the legalization and the combination of legal capitalism and addictive drugs. Marketing is a concern and lobbying power. Consider that tobacco is still not regulated by the FDA.

Third, in Michigan 23% of adults are regular smokers, and 52% of youth report having tried smoking with 16% of them before the age of 13. While tobacco policy has been successful in many ways, these numbers are still to high to offer comfort in moving towards tobacco as a model.

Fourth tobacco policy is in a state of rapid change. Who knows where it will be 5, 10 or 25 years from now? Is it inconceivable that some states or countries could be moving toward making tobacco sales illegal?

Finally, "During a prescribed heroin trial in Switzerland...about seven per cent quit during their time in the program." Talk about the soft bigotry of low expectations. The only kind of person who would point to this as an argument in favor of this policy is a person who believes that heroin addicts can't get well.

Another column from Newsday, "In the war on drugs, a tax plan that makes sense", raises inconsistencies in drug harms and their legality while arguing for higher tobacco taxes. He stops short of calling for any other drug policy change but he begs the question:

Will higher prices really push smokers to stop? Will $7 packs persuade kids not to start? Or is the lure of smoking and grip of addiction so all-powerful, the customers will pay whatever it costs?

Most of the research says that higher prices have the most impact on teenagers. They have less money in their pockets, even in the affluent 'burbs. At the same time, tax opponents warn about a rise in tax cheating, counterfeiting and illicit sales from Indian reservations, should higher taxes come in.

Only one thing is certain: This debate will never be settled on the facts. Addiction issues almost never are, and that certainly applies to the new suburban cigarette-tax debate.

Why is tobacco legal and marijuana not? Why is alcohol taxed, while cocaine and heroin are just available? Is it because some of these substances are more dangerous than others?

Of course not. We've never had a War on Drugs in America. We've always had a War on Some Drugs. And the teams were never chosen rationally.

The prestigious British medical journal The Lancet published a fascinating study last month.

Researchers from Oxford and Bristol universities set a straightforward challenge for themselves: Make a science-based assessment of the harm caused by various drugs, legal and illegal.

The researchers relied on three scales: the physical harm to the user, the drug's addictiveness, and its impact on the user's family and community.

Their data are hard to argue with: Alcohol and tobacco are more harmful than marijuana or ecstasy. Heroin and cocaine topped the list as most harmful. But there was hardly any connection at all, the scientists pointed out, between the harm a drug does and how the law has chosen to treat it.

Otherwise, pot would be legal. Tobacco and alcohol would not.

No one in the New York area yesterday was calling to make cigarettes illegal, even if they have now been banned from offices, restaurants, sports arenas and bars. (Suozzi did mention adding public parks to the no-smoking list.)

No one likes to pay more, even in a sin tax.

But if an extra $2 a pack will make some adults smoke less and persuade a few kids not to start, at least the change is connected to some kind of reality.

In this war, at this time, with these drugs, that's actually saying something.

Sen. Biden Introduces Legislation to Help Erase Stigma of Addiction

Senator Biden proposes removing the unfortunate term "abuse" from federal addiction agencies:

Sen. Biden’s legislation (S. 1011) will change the name of the National Institute on Drug Abuse (NIDA) to National Institute on Diseases of Addiction, and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to the National Institute on Alcohol Disorders and Health.

“Addiction is a neurobiological disease – not a lifestyle choice – and it’s about time we start treating it as such,” said Sen. Biden. “We must lead by example and change the names of our Federal research institutes to accurately reflect this reality. By changing the way we talk about addiction, we change the way people think about addiction, both of which are critical steps in getting past the social stigma too often associated with the disease.”

Preventing Underage Drinking: Using Getting To Outcomes with the SAMHSA Strategic Prevention Framework to Achieve Results

Preventing Underage Drinking: Using Getting To Outcomes with the SAMHSA Strategic Prevention Framework to Achieve Results:

Underage drinking is a significant problem in the United States: Alcohol is the primary contributor to the leading causes of death among adolescents. As a result, communitywide strategies to prevent underage drinking are more important than ever. Such strategies depend on the involvement and education of adolescents, parents, law enforcement officials, merchants, and other stakeholders. This guide is designed to take communities through the process of planning, implementing, and evaluating strategies to prevent underage drinking and youth access to alcohol. The guide is structured according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Strategic Prevention Framework, a five-step prevention approach. Within the five steps, the guide adopts the Getting To Outcomes model of empowerment evaluation, results-based accountability, and continuous quality improvement. The result is a comprehensive, step-by-step manual for developing, implementing, and evaluating a high-quality communitywide plan to prevent underage drinking and its related consequences. Recommendations include the development of educational strategies for parents, adolescents, and alcohol merchants; attracting the involvement of civic leaders; working to reform legislation governing underage access to alcohol; and training law enforcement officials to be vigilant but safe in their efforts to police underage drinking in the community.

Reader Response: School Drug Testing

Reader responses from the NYT on school drug testing. I'm assuming that the paper made an attempt to keep the published letters representative of all that they received. I'm genuinely surprised at the number of responses that are supportive of testing. I support testing for cause, but random testing troubles me. Random or limited, my biggest concern is what we do with kids who test positive. Locally, there simply isn't help for them.

Opium for the people: Extraordinary move to legalise poppy crops (U.K.)

Tony Blair is considering call for legalizing Afghani opium crops:

The buds of millions of poppy flowers are swelling across Afghanistan. In the far southern provinces bordering Iran, the harvest will start later this month. By mid- May the fields around British military camps in Helmand will be ringing to the sound of scythes, rather than gunfire.

And this year's opium harvest will almost certainly be the largest ever. In the five years since the overthrow of the Taliban regime, land under cultivation for poppy has grown from 8,000 to 165,000 hectares.

The US wants to step up eradication programmes, crop-spraying from the air. But, desperate to win "hearts and minds" in Afghanistan and protect British troops, Tony Blair is on the brink of a U-turn that will set him on a collision course with President George Bush.

The Prime Minister has ordered a review of his counter-narcotics strategy - including the possibility of legalising some poppy production - after an extraordinary meeting with a Tory MP on Wednesday, The Independent on Sunday has learnt. Tobias Ellwood, a backbencher elected less than two years ago, has apparently succeeded where ministers and officials have failed in leading Mr Blair to consider a hugely significant switch in policy.

Supporters of the measure say it would not only curb an illegal drugs trade which supplies 80 per cent of the heroin on Britain's streets, but would hit the Taliban insurgency and help save the lives of British troops. Much of the legally produced drug could be used to alleviate a shortage of opiates for medicinal use in Britain and beyond, they say.

A Downing Street spokesman confirmed last night that Mr Blair is now considering whether to back a pilot project that would allow some farmers to produce and sell their crops legally to drugs companies. His change of heart has surprised the Foreign Office, which recently denied that licit poppy production was being considered. A freedom of information request has revealed that the Government looked carefully at proposals to buy up Afghanistan's poppy crop as early as 2000, under the Taliban. The removal of that regime - justified to both US and British voters partly in terms of a victory in the "war on drugs" - has made it politically difficult to financially reward poppy farmers.

New York City Is Hell for Pot Smokers

I don't have much to say about this. The racial disparity, particularly in sentencing is troubling:

Of the more than 395,000 defendants busted in New York City since 1980 for puffing or possessing pot in public, nearly 336,000 of them (85 percent) were either African-American or Hispanic. By contrast, African-Americans and Hispanics together comprise approximately half of the city's population.
...
The unequal treatment of minorities for misdemeanor pot crimes is not just limited to arrests, the study finds. Investigators also report that African-Americans were 2.66 times as likely as whites to be detained in jail pending arraignment while Hispanics were nearly twice as likely. In addition, both groups were twice as likely as whites to receive a conviction -- and criminal record -- for public pot possession. Compared to Caucasians, African-Americans were four times as likely and Hispanics were three times as likely to receive jail time.

The other reaction I have is that the relevant laws seem to already be pretty permissive:

(Although the possession of less than 25 grams of pot is punishable under state law by a fine-only civil citation, New York Statute 221.10 defines the possession or use of marijuana "open to public view" as a criminal misdemeanor punishable by up five days in jail.)

Possession is of less than 25 grams is subject to a fine? (That's one ounce of weed!) Smoking weed in public is subject to up to 5 days? As acknowledged frequently on this blog, reasonable people can disagree about whether pot should be legalized, but these laws are hardly draconian or oppressive. Is it so hard to smoke your weed in private?

I guess I had more to say than I thought.

UPDATE-I got the following comment from a friend:

Jason, I'm sorry but I had to laugh, because I'm guessing that to the average American who is not experienced with buying drugs - an ounce of weed sounds like enough for, not much, maybe a joint. I didn't comprehend how much an ounce of weed was until [someone I know] got busted with an ounce and the nice police officer explained why they tossed him in jail.

An ounce is a lot of weed. It's 30 to 60 joints depending on who you ask. According to Erowid, the price for an ounce varies from $120 to $480 and generally could get 160 to 240 people moderately high.