Will a New Study Force Changes in Drug Law?

AlterNet has published a well written reaction to the release of the British RSA drug policy report. The author has a clear bias but he is right that this offers a useful framework for discussion.

I question his near Utopian characterization of England--as this blog frequently posts, they're having problems of their own.

While I agree that we need major changes in drug policy, he paints the shedules in the U.S. Controlled Substances Act as irrational (almost deliberately so). Those schedules are based on a combination of abuse potential and accepted medical utility--this may or may not be the best way to classify drugs, but it's not all that irrational. It might be helpful to revisit the drug schedules, but the real problem seems to lie in penalties.

Finally, reform advocates who seek decriminalization seek to present the possibility of drug policy decisions as wholly rational and something akin to an accounting exercise. Considering the harms that drugs cause and ranking those harms is impossible to do objectively--this has to be a subjective exercise, and values will inevitably enter the equation.

After two years of research, this panel of experts and laypeople came to a number of conclusions so sensible and so obvious that it's astonishing how consistently our elected leaders have avoided confronting them. In particular:

• The notion of a drug-free society is "almost certainly a chimera. ... People have always used substances to change the way they see the world and how they feel, and there is every reason to think they always will." Therefore, "[t]he main aim of public policy should be to reduce the amount of harms that drugs cause." A policy based on total prohibition "is bound to fail."
  
  
• The concept of "drugs" should include tobacco and alcohol. "Indeed, in their different ways, alcohol and tobacco cause far more harm than illegal drugs." These substances should be brought into a unified regulatory framework "capable of treating substances according to the harm they cause."
  
  
• The heart of this new regulatory framework must be an index of substance-related harms. "The index should be based on the best available evidence and should be able to be modified in light of new evidence."
  
  
• We need a new way of evaluating the efficacy of drug policies. "In our view, the success of drugs policy should be measured not in terms of the amounts of drugs seized or in the number of dealers imprisoned, but in terms of the amount of harms reduced."

As an example of the sort of harms index they envision, the RSA Commission points to an index developed by a pair of British scientists, David Nutt and Colin Blakemore, and published in a House of Commons report last year.

Based on scientific evaluations of physical harms (e.g., acute and chronic toxicity), likelihood of dependence, and social harms (including damage done to others, health care costs, etc.), Nutt and Blakemore ranked 20 different classes of drugs, both legal and illegal. Not surprisingly, heroin was at the top of the harm scale, followed by cocaine and barbiturates. Alcohol and tobacco were rated as significantly more harmful than marijuana and several other illegal substances.

While not specifically endorsing the Nutt/Blakemore index, the RSA Commission clearly considered these rankings a good example of what they have in mind, using them as a starting point for illustrations of how such an index might translate into law. Marijuana, they wrote, "should continue to be controlled. But its position on the harms index suggests that the form this control takes might have to correspond far more closely with the way in which alcohol and tobacco are regulated."

Both the United States and Britain now have drug laws that rank drugs into a series of classifications. The problem -- well, at least one problem -- is that these classifications have little connection to what the science actually tells us about the dangers (or lack thereof) of different substances. Britain's version, the commission noted, "is driven more by 'moral panic' than a practical desire to reduce harm. ... It sends people to prison who should not be there. It forces people into treatment who do not need it (while, in effect, denying treatment to people who do need it)."

And Britain's law is, on at least one key point, far more rational than the U.S. Controlled Substances Act. The British classify marijuana in the lowest of three classes of illicit drugs -- still illegal, but treated as less dangerous than cocaine, heroin or methamphetamine. Simple possession, without aggravating circumstances, is generally a "nonarrestable" offense.

Our CSA ranks marijuana in Schedule I, the worst class of drugs -- considered not only to be at high risk of abuse but also to be unsafe for use even under medical supervision -- along with heroin and LSD. Amazingly, cocaine and meth are in Schedule II -- considered acceptable for use under medical supervision. That such a ranking is insane should not need to be stated.

There are plenty of specifics in the RSA report about which reasonable people can disagree. But the important thing is not what they say about any specific drug -- and indeed, the report is careful not to advocate specific legal changes for particular drugs. What's important is that it suggests a framework that's far more rational than what now exists in the United States, Britain and most other countries: A reality-based approach rooted in sound science, focusing on how to reduce harm.

Man Who Sent Apology Sentenced for Rape

The man who was charged with rape after offering 9th step amends to his victim (earlier post here) has been sentenced:

A man who sexually assaulted a University of Virginia student in 1984 and apologized to her two decades later as part of the Alcoholics Anonymous program was sentenced to 18 months in prison Thursday.

Flawed research equates placebo to cold turkey

Why placebo should not be equated with cold turkey:

...can people who volunteer to test a drug, but who are randomly assigned to get a placebo instead of the drug they wanted, reasonably be compared to people who decide to quit smoking without drugs? A growing chorus of independent experts and health advocates are expressing concern that the pharmaceutical industry has either divorced itself from common sense or is intentionally deceiving smokers.

"Pharmacotherapy in general is over-emphasized," asserts Dr. Michael Siegel, a physician and professor at Boston University School of Public Health. "Most smokers who quit successfully long-term are those who quit cold turkey without any particular pharmaceutical aids."

Stupid drug story of the week: A strange cocktail mixed by the Times

Jack Shafer vents his spleen over a NYT story I posted about earlier this week. His criticism that this story may be hyped is probably fair. However, he also reveals his bias:

Not that long ago, every reporter knew his way around the bottle. He kept a pint in his bottom drawer at work, adjourned to bars for lunch, and as often as not, went to bed with a slight buzz on. But in today's puritanical newsroom, alcohol has become as verboten as methamphetamine, heroin, marijuana, cocaine, and MDMA. Reporters, who could once file dispassionate stories on the topic, have become as hysterical as 12-steppers falling off the wagon when assigned to write a booze story.

Wasting the Best and Brightest

From CASA:

The report finds that from 1993 to 2005 there has been no real decline in the proportion of students who drink (70 to 68 percent) and binge drink (40 to 40 percent). However, the intensity of excessive drinking and rates of drug abuse have jumped sharply:

• Between 1993 and 2001 the proportion of students who binge drink frequently is up 16 percent; who drink on 10 or more occasions in a month, up 25 percent; who get drunk at least three times a month, up 26 percent; and who drink to get drunk, up 21 percent.
• Between 1993 and 2005 the proportion of students abusing prescription drugs increased:
• 343 percent for opioids like Percocet, Vicodin and OxyContin;
• 93 percent for abuse of stimulants like Ritalin and Adderall;
• 450 percent for tranquilizers like Xanax and Valium;
• 225 percent for sedatives like Nembutal and Seconal.
• Between 1993 and 2005, the proportion of students who:
• Use marijuana daily more than doubled to 310,000.
• Use cocaine, heroin, and other illegal drugs (except marijuana), is up 52 percent to 636,000.

This may be a good argument for better typology within the use/misuse/dependence continuum.

Lawmakers Consider Less Crack Penalties

Congress finally looks to address the crack/powder sentencing disparity. However, Reason Magazine reports that Sessions' bill would reduce crack penalties and increase powder penalties. Let's hope that the legislative process brings a little sanity. Does anyone really think that we're too lenient with powder cocaine penalties?

Momentum is building in Congress to ease crack cocaine sentencing guidelines, which the American Civil Liberties Union and other critics say have filled prisons with low-level drug dealers and addicts whose punishments were much worse than their crimes.

Federal prison sentences for possessing or selling crack have far exceeded those for powder cocaine for two decades. House Crime Subcommittee chairman Robert Scott, D-Va., a longtime critic of such sentencing policies, plans to hold hearings on crack sentences this year. In the Senate , Republican Jeff Sessions of Alabama is drawing bipartisan support for his proposal to ease crack sentences.

"I believe that as a matter of law enforcement and good public policy that crack cocaine sentences are too heavy and can't be justified," Sessions says. "People don't want us to be soft on crime, but I think we ought to make the law more rational."

The mandatory federal sentencing guidelines passed by Congress in 1986 require a judge to impose the same sentence for possession of 5 grams of crack as for 500 grams of powder cocaine: five years in prison.

...

"We're going to address all the mandatory minimums," said Scott, chairman of the House Judiciary Committee's Subcommittee on Crime, Terrorism and Homeland Security. "The crack cocaine is probably the most egregious because of its draconian number of years for relatively small amounts."

Opposition to weaker sentences has come from police, prosecutors and law enforcement agencies such as the Justice Department and the Drug Enforcement Administration.

"We believe the current federal sentencing policy and guidelines for crack cocaine offenses are reasonable," Justice spokesman Dean Boyd says.

Higher penalties for crack offenses reflect its greater harm, he says, adding that crack traffickers are more likely to use weapons and have more significant criminal histories than powder cocaine dealers.

"Congress thought by having very harsh sentences, it would deter the spread of crack into the inner cities and around the country," Sessions says. "The truth is, it didn't stop it. It spread very rapidly. Now we need to ask ourselves, what is the right sentence for this bad drug. I think it's time to adjust. I think it's past time to do this."

Brain cue response predicts relapse

From NIDA:

...investigators recruited 17 men and women who were participating in a trial of an antidepressant—sertraline—that is being evaluated as a possible treatment for cocaine addiction. The participants reported abusing cocaine 20 days, on average, during the month before the study. All met standard clinical criteria for cocaine addiction and had abused the drug for 6 years, on average. Most were new to treatment.

After being cocaine-free for 5 days, on average, each participant underwent functional magnetic resonance imaging (fMRI) while watching two 4-minute videotapes. The first minute of each tape reported on vegetable prices, and the participants' brain activity while hearing this emotionally neutral information served as a baseline for comparison. During the last 3 minutes, an actor pretended to smoke cocaine and experience a "rush." Immediately after viewing the tapes, each participant rated peak cocaine craving intensity on a scale from 0 to 10. After the imaging session, participants began taking either sertraline or a placebo daily and completed 2 weeks of residential treatment. During the 10-week outpatient phase of the trial, they were to continue their medication regimen, receive weekly individual cognitive-behavioral therapy, and submit urine samples three times a week.

Nine of the 17 participants relapsed, defined by the investigators as submitting fewer than 15 of a possible 30 cocaine-free samples during the study and not completing outpatient treatment. Participants taking sertraline were just as likely as those taking the placebo to relapse. Relapsers and nonrelapsers reported cue-induced cravings of comparable intensity. The two groups differed, however, on brain activation during the first 30 seconds of the cocaine-cue videotapes. Relapsers showed greater cue-induced activation than nonrelapsers in several areas of the cortex: the left precentral (movement control), right superior temporal (auditory processing), right lingual and right inferior occipital (visual processing), and the left posterior cingulate cortices. The cingulate cortex is integral to attention, response inhibition, emotional regulation, and decisionmaking.

The definition of relapse inspires a lot of confidence, no?

For U.S. Troops at War, Liquor Is Spur to Crime

A troubling about U.S. troops, liquor and crime (Requires free registration. If you don't wish to register, you can use www.bugmenot.com.):

Alcohol, strictly forbidden by the American military in Iraq and Afghanistan, is involved in a growing number of crimes committed by troops deployed to those countries. Alcohol- and drug-related charges were involved in more than a third of all Army criminal prosecutions of soldiers in the two war zones — 240 of the 665 cases resulting in convictions, according to records obtained by The New York Times through a Freedom of Information Act request.

Seventy-three of those 240 cases involve some of the most serious crimes committed, including murder, rape, armed robbery and assault. Sex crimes accounted for 12 of the convictions.

The 240 cases involved a roughly equal number of drug and alcohol offenses, although alcohol-related crimes have increased each year since 2004.

Despite the military’s ban on all alcoholic beverages — and strict Islamic prohibitions against drinking and drug use — liquor is cheap and ever easier to find for soldiers looking to self-medicate the effects of combat stress, depression or the frustrations of extended deployments, said military defense lawyers, commanders and doctors who treat soldiers’ emotional problems.

“It’s clear that we’ve got a lot of significant alcohol problems that are pervasive across the military,” said Dr. Thomas R. Kosten, a psychiatrist at the Veterans Affairs Medical Center in Houston. He traces their drinking and drug use to the stress of working in a war zone. “The treatment that they take for it is the same treatment that they took after Vietnam,” Dr. Kosten said. “They turn to alcohol and drugs.”

Exec’s private pain fuels HBO’s ‘Addiction’

This HBO series' (debut's Thursday at 9pm) promotional machine is amazing--there are ads everywhere. More evidence that parents and other loved ones are the key to changing drug policy and treatment access:

HBO unleashed some of the industry’s best documentary filmmakers to take on the subject of addiction, a project born from the frustration of a top HBO executive whose son has struggled with alcohol and cocaine problems.
...

It all began with the realization by Sheila Nevins of HBO that she understood little about the problems bedeviling her son David.

...

All of the documentaries will be available to download for free off HBO’s Web site. HBO also timed the series to air on one of its periodic weekends where the service is offered for free to entice new viewers.

The series strongly communicates the message of addiction as a brain disease, which is not entirely accepted by the public or even the medical community, said Nora Volkow, director of the National Institute on Drug Abuse.

“We need to create an empathy so we don’t react with anger and a stigma to the person who is addicted, which doesn’t help anyone — the person or society,” Volkow said.

HBO has done a handful of campaigns like this in the past, on issues like AIDS and cancer, and supported Nevins’ efforts here.

While still exploring the idea, HBO brought groups of people together to talk about addiction to hear their attitudes and experiences. A key moment in moving forward came when Nevins heard the story of one woman and her two children, one who had epilepsy and another who was an addict. The woman cared for the child with epilepsy and kicked the addict out of her house.

Now she has only one child — the addict is dead — and the decision not to seek medical help haunts her to this day.

“It gives dignity to the addict,” Nevins said of the HBO project. “They are responsible for seeking treatment, not responsible for the disease.”

Anti-Drug Spending Would Decline Under Bush Budget, Analysts Say

Join Together reports that the President's new budget calls for increases in spending on law enforcement and interdiction at the expense of treatment and prevention.

For the first time in about 20 years, spending on federal anti-drug programs would actually decline on a year-over-year basis if the Bush administration's 2008 drug budget is adopted, according to an analysis by Carnevale Associates.

The administration's proposed $12.961 billion drug-control budget not only represents a $166.7-million decline from 2007 spending levels, it also cuts prevention spending while continuing to increase funding for overseas and interdiction programs -- a puzzling strategy when major drugs of abuse -- prescription drugs and marijuana -- are mostly domestically produced," noted the Carnevale Associates policy brief.

"Perhaps most puzzling, however, the FY 2008 budget trend goes against well-established principles of effective drug-control policy, including the need for a comprehensive balanced approach between interdiction, law enforcement, overseas programs, and prevention and treatment programming," the report says. "Specifically, the FY 2008 budget request continues the Bush administration's long-term trend of shifting resources away from demand reduction ... toward supply reduction."

Since 2002, supply reduction has gone from 55 percent of the federal drug budget to a proposed 64 percent in 2008, according to Carnevale's analysis. Over this time span, funding for drug interdiction programs rose 72 percent, domestic law-enforcement funding rose 27 percent, and overall supply-reduction efforts received 42 percent more federal funding.

Meanwhile, the administration's FY2008 request -- if approved by Congress -- highlights the far less generous trends in funding for demand-reduction activities. While treatment funding rose a modest 9 percent from 2002 to the proposed 2008 funding levels, prevention will have declined by 3 percent from FY2002 to FY2008. "The decline in demand reduction is driven entirely by a reduction for substance-abuse prevention," which would receive 21 percent less federal funding in 2008 than it did in 2002 under the administration's proposal, according to the Carnevale report. Cuts to the Safe and Drug-Free Schools and Communities program and the budget of the Center for Substance Abuse Prevention account for most of the funding decline.

According to Carnevale, the FY2008 budget flies in the face of a series of campaign promises made by President Bush in 2001, including big spending increases for addiction treatment for teenagers (entirely unfunded to date), drug courts (down to $7 million in 2007 from $50 million in 2002), drug-free schools (cut drastically in recent years), and drug-free workplaces (unfunded).

"Had ONDCP followed through on these promises for treatment, education, drug-free communities, and drug courts, the share of the budget devoted to demand reduction would have been approximately 42 percent in FY 2008, rather than the 36 percent currently budgeted," Carnevale noted.

A new British drug classification report

A British government report with recommendations about drug classifications was released last week. Here are a couple of articles on the report (here and here.)

I'm sympathetic to arguments that drug classifications have been based on panic, racism, demagoguery, and false dichotomies. However, drug policy advocates who insist on characterizing the masses as unenlightened, guilty of "moral panic" and just persistently stupid are every bit as maddening as the drug war proponents. There are important ways in which they are right, but they fail to recognize the ways in which their "opponents" are right, or at least legitimately concerned. The argument that some people use heroin, have a steady relationship, are employed and have children is not very persuasive. It may be true, but it's misleading. (Transparently misleading, at that.)

I suspect that most people would be open to the arguments of many of these policy advocates if they weren't so absolutist and narrowly focused. I think most people are willing to go for drug reclassification, alternatives to incarceration and many harm reduction strategies. They're just not willing to go for those ideas alone. They also want to be sure that their children are safe and they want to make sure we treat people suffering from addiction. I'm not a fan of his, but look at this segment from Lou Dobbs (about 2/3 down the page). He looks like he may be open to reconsidering his advocacy for widespread adolescent drug testing, he's supportive of some harm reduction strategies and doesn't want to see people simply sent off to prison/jail. BUT, he also wants interdiction, treatment and, I assume, some form of criminalization. (Probably without knee-jerk incarceration.) The point is that most people are not willfully ignorant--listening is as important as advocacy.

An open trial of CBT for insomnia comorbid with alcohol dependence

Good news about the effectiveness of CBT for insomnia in alcoholics:

Results:
Diary-rated sleep latency [F (2, 10) = 14.4, p < .001], wake after sleep onset [F (2, 10) = 7.7, p = .009], and sleep efficiency [F (2, 10) = 28.3, p < .001] improved as did patient-rated and clinician-rated Insomnia Severity Index (ISI) and the Dysfunctional Beliefs and Attitudes about Sleep – Short Form (DBAS-SF). Compared to pre-treatment, significant post-treatment improvements were found on scales measuring depression and anxiety symptoms, fatigue, and quality of life. No one relapsed to alcohol during treatment.

Conclusions:
Cognitive-behavioral insomnia therapy may benefit recovering alcoholics with mild to moderate insomnia by improving sleep and daytime functioning. Effects on relapse remain to be determined. Findings need to be interpreted cautiously due to the uncontrolled design and lack of follow-up assessments.

Doctors: School drug testing a bad idea - Kids & Parenting - MSNBC.com

The American Academy of Pediatrics weighs in on drug testing kids, saying that they are unreliable and can create a climate of distrust suspicion and fear.

Subjecting children to drug testing is usually a bad idea for a host of reasons, including often inaccurate results and loss of the child’s trust, a leading pediatricians’ group said on Monday.

Increasingly, schools are embarking on drug testing, particularly of student-athletes, following a 2002 U.S. Supreme Court ruling that declared the practice legal.

Parents may also be tempted by newly available home drug screening kits in an effort to catch the problem early.

But the American Academy of Pediatrics, updating its decade-old policy statement on the issue, said screening for illicit drugs is a complicated process prone to errors and cheating, and has not been shown to curtail youngsters’ drug use.

Drug testing also creates a counterproductive climate of “resentment, distrust and suspicion” between children and their parents or school administrators, a committee of experts wrote in the March issue of the group’s journal, Pediatrics.

False-positive results can arise from eating poppy seeds or ingesting certain cold medications, and test results may need to be confirmed with expensive further testing, it said.

Many students are also likely to be aware of Web sites that offer methods of defeating drug testing.

In addition, several illegal drugs are undetectable in urine more than 72 hours after use, and standard tests do not detect often abused substances such as alcohol, Ecstasy and inhalants. Some youngsters may respond to testing by avoiding drugs such as marijuana and instead abuse less-detectable, but more dangerous, drugs, the statement said.

“A key issue at the heart of the drug-testing dilemma is the lack of developmentally appropriate adolescent substance abuse and mental health treatment” in many communities, it said, noting existing programs designed for adults may be unsuitable for children.

The report suggested parents suspicious that a child is abusing drugs or alcohol consult the child’s primary care doctor rather than rely on school-based drug screening or home kits to check their concerns.

Vancouver teens lead in drug and alcohol use

Is this a consequence of Vancouver's drug policy?:

A new survey has found that people between 16 and 25 in this city are more likely to experiment with alcohol and drugs than young people elsewhere in Canada.

The Vancouver Coastal Health Authority says it found 54 per cent of young people who were surveyed had smoked marijuana or cigarettes in the past year, while nine out of 10 had drunk alcohol.

Young men are more likely to try pot, mushrooms and cocaine, while young women use ecstasy more.

One-third said they tried drugs because they were curious and most think pot is the least risky drug.

HBO's Addiction Series

I went to a premiere of the new HBO addiction series last night and have a few thoughts.

On the positive side:

• A really good segment on the latest in brain imaging. The also used a helpful way of explaining the role of dysfunction in limbic system and the frontal cortex. They described the limbic system as the "go" center of the brain and the frontal cortex as the "stop" center of the brain.
• There was a very powerful segment on insurance parity advocacy efforts in Pennsylvania.
• There was an inspiring segment about a steamfitter labor union local that became self-insured to avoid managed care restrictions on treatment access, developed recovery support groups for members, and developed a strong EAP program to intervene with and support union members.

On the down side:

• It was not as hopeful as I would have liked. The emphasis was on addiction and treatment, rather than recovery. I thought that someone without much knowledge or experience might leave with the impression that recovery is the exception to the rule. I also thought that it presented treatment as the only viable pathway to recovery.
  
• There was very little diversity. Almost all of the people depicted were white.
• There was a lot of attention to pharmacotherapies and no portrayal of mutual aid groups.
• One expert from a treatment program in Maine stated that 90% of opiate addicts are unable to achieve recovery without drug maintenance therapy. He went on to state that buprenorphine may be effective for people who are mildly addicted or only addicted to prescription medication, but that injection opiate addicts require methadone maintenance.

It was definitely worth seeing. My impression is that this 90 minute episode will air on March 15th and thirteen shorter episodes will follow. Hopefully the additional episodes will address some of the weak points in the first episode.

Funding treatment programs can save much pain, greater expenses down the road

From the Detroit Free Press:

Gov. Jennifer Granholm says the state needs to raise money for a better future while cutting spending for the present. But there's also a way to invest in the present that could save a fortune now -- and down the road.

Take a slice of the governor's proposed tax increase on liquor, add a piece of the higher taxes that also should be imposed on beer, and pour the money into treatment programs for drug and alcohol abusers. Cut into the physical damage these folks do and the crimes they commit and you get huge savings in health care, law enforcement, courts and prisons, where 80% of the inmates have histories of drugs or alcohol abuse. Intercept chemically addled people on their inevitable downward spiral and you can make them productive taxpayers, instead of a burden. Intervene early enough with a young person headed for trouble and you save not only millions of dollars but also a life. Lives, even, when you count the innocent victims of drunken drivers.

And yet, despite a conservative estimate of $2.7 billion in annual costs from addiction, Michigan ranks last among the 50 states in the share of the state budget spent for substance abuse programs.

Michigan does have treatment programs and diversion projects and sobriety or drug-abuse courts that have impressive results, but the state doesn't attack addiction the way it does other diseases. Why not? Well, the booze business, which now advertises more than ever, seems to think that it's doing enough with those "drink responsibly" tags on the commercials. And the public, despite overwhelming evidence to the contrary, doesn't buy drug or alcohol addiction as a disease, seeing it instead as a personal problem, a lack of willpower, even a shame.

In Detroit, that false notion will be attacked this month as part of a national effort that local treatment advocates hope will result in more public money dedicated to fight an enormously costly problem. (By the way, if setting aside some of the beer and liquor taxes won't work, what about some of the money from unclaimed can and bottle deposits, an estimated $50 million a year now split between the state and beverage retailers?)

Some Brains May Be Predisposed to Substance Abuse

We've known for some time that dopamine D2 receptors play an inportant role in addiction, but this is news:

Do the brain changes noted in drug addicts help cause their addiction, or are they the result of drug abuse?

A new study might solve that chicken-and-egg puzzle - pointing to new ways of preventing and treating addiction, researchers say.

The rat study suggests that "some individuals may be predisposed to the effects of cocaine on the brain," making them more likely to try the drug and become addicts, said lead researcher Dr. Jeffrey Dalley, of Cambridge University's Behavioural and Clinical Neuroscience Institute in the United Kingdom.

Specifically, rats that went on to compulsively self-administer cocaine intravenously were more likely to have fewer brain cell-surface receptors for the neurotransmitter dopamine in an area of the brain called the nucleus accumbens, compared to rodents that were less prone to addiction.

"The study is the first to conclusively demonstrate that changes in dopamine receptors in the nucleus accumbens pre-date cocaine use," Dalley said. That means that these brain changes are not caused by cocaine exposure but may encourage use of the drug.

Medical pot cuts pain, study finds

A recent study finds that marijuana is effective at relieving neuropathy pain in AIDS patients.

I'm not opposed to medical marijuana is it really is an effective medical treatment and it goes through the same approval process as any other drug. (However, it would seem to be important to find a route of administration better than smoking.) Unfortunately, all the competing political and social agendas make all the information suspect. The result is that I'm suspicious of everyone. As drug warriors often allege, many medical marijuana advocates appear to be guilty of hiding other agendas behind compassionate medical arguments. As harm reduction and medical marijuana advocates often allege, opponents are often guilty of irrational hysteria and hiding moral judgments behind bad science.

Doctors at San Francisco General Hospital reported Monday that HIV-infected patients suffering from a painful nerve condition in their hands or feet obtained substantial relief by smoking small amounts of marijuana in a carefully constructed study funded by the state of California.

Although the study was small, it is the first of its kind to measure the therapeutic effects of marijuana smoking while meeting the most rigorous requirements for scientific proof -- a randomized, double-blind placebo-controlled trial.

As such, the results of the trial are being hailed by medical marijuana advocates as the most solid proof to date that smoking the herb can be beneficial to patients who might otherwise require opiates or other powerful painkillers to cope with a condition known as peripheral neuropathy.

The federal government has taken a hard line against marijuana use for medical purposes, maintaining that smoking it is harmful and that there is no scientific evidence to support its legitimacy for treatment in the United States. The U.S. Supreme Court in 2005 ruled that medical marijuana patients can be prosecuted by the government, even in states like California where medical use has been legalized.

"It's time to wake up and smell the data," said Bruce Mirken, spokesman for the Marijuana Policy Project, a group advocating the legalization of the drug for medicinal purposes. "The claim that the government keeps making that marijuana is not a safe or effective medicine doesn't have a leg to stand on."

The study found that most volunteers who were given three marijuana cigarettes a day experienced a significant drop in the searing pain of peripheral neuropathy, which patients liken to a stabbing or burning sensation, usually on the bottoms of their feet. HIV patients are not the only group to experience peripheral neuropathy -- many types of the condition have been identified, and it can also afflict diabetics, cancer patients and people with injuries or infections that affect nerve tissue.

On average, the experiment's participants reported at the start that their pain was roughly at midpoint on a 100-point scale, where zero was no pain at all and 100 was "the worst pain imaginable."

At least half the volunteers who smoked the active marijuana experienced a 72 percent reduction in pain after their first cigarette on the first day of the trial. Over five days, the median reduction in pain reported by the marijuana smokers was 34 percent, compared with 17 percent reported by those who smoked placebo cigarettes that had the active ingredient THC removed in a process akin to decaffeinating coffee.

"This is evidence, using the gold standard for clinical research, that cannabis has some medicinal benefits for a condition that can be severely debilitating," said Dr. Donald Abrams, lead author of the study released Monday by the journal Neurology.

You Can Have Free Drugs, but Only If You Don't Behave Yourself

A libertarian (and disease model skeptic) response to the Vancouver plan to offer drug maintenance for cocaine and methamphetamine addicts:

The rhetorical and policy contortions produced by prohibition are something to behold. Instead of allowing adults to obtain oral stimulants for whatever purpose they like (which was the situation in the U.S. until the government started requiring a prescription for amphetamines in 1954 and even for a decade or so afterward, when prescriptions were easy to come by), the government drives them into the black market and then allows the select few who are sufficiently fucked up to get oral stimulants at taxpayers' expense. Meanwhile, doctors commonly prescribe stimulants to people who have trouble focusing and paying attention, a condition that used to be self-treated but nowadays is recognized as a disease requiring professional diagnosis. If you take these drugs without that diagnosis, you also have a disease—drug dependence—that one day, if we're lucky, may be treated by giving you the drugs.

Vancouver mayor announces new program to fight drug addiction and crime

Vancouver mayor, Sam Sullivan, appears to be forging ahead with his plan to create drug maintenance programs for drug addicts. The plan is called CAST (Chronic Addiction Substitution Treatment). I've posted before on the subject here and here, so I won't repeat what I've already written. I will add, however, that Vancouver built a lot of support for its "four pillar" approach to addiction with the promise of treatment as one of the pillars. I suspect that this was not what many of those stakeholders had in mind.

If your from southeastern Michigan, you may be wondering how this is relevant to us. The answer is that Vancouver is frequently pointed to as an innovative model for responding to addiction.

Nicotine wars

Dr. Wes, a physician and blogger, offers his take on recent concerns over slowed progress on smoking cessation and low utilization of nicotine replacement therapy. He offers some pretty provocative opinions that are worth taking the time to read.

It still puzzles me that we use an incredibly addictive drug, nicotine, to help smokers quit their habit. It's like we've given up and decided that Nicorette gum is to the smoking addiction as methadone is to a heroin addiction. To make matters worse, it now seems that the pharmaceutical industry, in its press to promote its products, wants to limit the verbage on the warning label on the smoking cessation drugs.
...
Over-regulation as the cause for lack of utilization? How about the methadone/heroin analogy? Maybe the reason people aren't using these meds is because they're expensive and people don't like taking drugs - especially one that is powerfully addictive. And there are even researchers who question the efficacy of these drugs to stop the smoking habit in the first place.
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The reality? We have been incredibly successful in the US at educating our population about the effects of smoking and reducing the number of individuals who smoke. Smoking bans have also been remarkably effective. Why make us smoke this lame excuse for "limited gains" of achieving our goals of smoking cessation in the interest of making pharmaceutical companies more money? Maybe, just maybe, the real reason that smoking cessation aides are producing only limited gains (in sales) is because fewer people are smoking.

There Is No Blame; There Is Only Love

From NPR's "This I Believe" series an essay from a mother of a young woman who has struggled with heroin addiction. After years of blaming herself and others, she now believes that there is no blame. Below is an excerpt, but follow the link and her the entire essay in her own voice.

You don't expect your child to grow up to be a heroin addict. From the moment of her birth, you have hopes and dreams about the future, but they never include heroin addiction. That couldn't happen to your child, because addiction is the result of a bad environment, bad parenting. There is most definitely someone or something to blame.

That's what I used to believe. But after failed rehab and long periods of separation from my heroin-addicted daughter, after years of holding my breath, waiting for another relapse, I now believe there is no blame.

...

I don't know why or how my daughter became addicted to heroin; I do know that it doesn't really matter. Life goes on, and Katie is still my daughter.

Katie and I meet for breakfast on Friday mornings now. We drink coffee and talk. I don't try to heal her. I just love her. Sometimes there is pain and sorrow, but there is no blame. I believe there is only love.

“You’ve Got to Stop”

A well done article about interventions with several quotes from our friend Jeff Jay. The article is from a Washington D.C. publication and gives special attention to the challenges of interventions with powerful and wealthy people.

The only passage that bothered me was this one:

A member of another DC-based group, Faces and Voices of Recovery, worries that George W. Bush’s solo effort to quit drinking sent the wrong message to those who think they can handle their addictions without help: “George Bush comes to town, and the impression they try to convey is that he just suddenly realized he had a problem and he stopped drinking and lived happily ever after.”

I'm no fan of Bush, but to suggest that his recovery narrative hurts the cause is silly. He doesn't present his path to recovery as the correct path and his message seems to affirm recovery in the broadest terms. As Bill White often says, "Recovery by any means necessary."

Ferguson Speaks From The Heart

Craig Ferguson on the Britney media frenzy and his own recovery:

NET for heroin gets boost in Scotland

A blog post on neuro-electric therapy (NET) in Scotland. Includes a link to the website of the manufacturer of NET equipment.

How Prohibition made Detroit a bootlegger's dream town

A little local history on prohibition in Detroit. Of special interest to anyone who knew Theresa M.

Is alcohol a "drug"? Why the question matters

Mark Kleiman offers a commentary about alcohol's cultural status as something other than a drug. I think he's guilty of a little hyperbole and condescension, but I find his point to be on the mark.

“In terms of its effects on the human body and psyche, alcohol is simply another psychoactive substance.” That sentence, with which Cook and Reuter begin their very able essay, embodies a proposition that will be taken as a truism by most readers of this journal, but would be regarded as a fallacy, an outrage, and an insult by many, if not most, ordinary citizens.

Why is that claim controversial, and why does the rejection of that claim matter?

It is controversial, I would submit, because the mood in which the public, its elected representatives, and their appointed officials consider drugs, drug-taking, and drug policy has little to do with the calm, evidence-based, policy-analytic tone taken by Cook and Reuter. The two scholars do not recite, because they do not believe, the basic credo underlying the international drug control regime, as well as the drug policies of most countries: outside a strictly medical context, drugs are fundamentally evil, drug-taking is both harmful and morally culpable, and drug-takers require some mixture of treatment and punishment. It is this credo that is threatened by any attempt to treat alcohol as a “drug.”

By contrast with any of the controlled drugs, alcohol use is neither statistically"

n particular, those who discuss drug policy (outside Islamic societies) have no obligation to pretend that they themselves are, nor any right to assume that their audiences are, abstinent from alcohol. Thus courtesy forbids even those who themselves do not drink, and disapprove of drinking, from referring to alcohol users generically as “drunkards” or “degenerates” or “slaves of the Demon Rum.” Problems with alcohol must therefore be treated, in Abraham Lincoln's formulation, as “the abuse of a good thing,” not “the use of a bad thing.”

But if alcohol is a drug, then “drug use” is normal, and not all drug use is abuse. That undercuts the entire project of stigmatization underlying much of what passes for “drug abuse prevention.” If smoking cannabis, snorting cocaine, swallowing MDMA (“ecstasy”), or even injecting heroin, are not different in principle from having a glass of wine, then the moral basis for treating cannabis-smokers, cocaine-snorters, rave-goers, and heroin-injectors as carriers of a deadly plague is called into question, and even suppliers of those drugs might be seen as regulatory violators rather than hostes humani generis (enemies of humankind) the modern incarnation of a legal category that used to cover pirates and slave-traders.

Conversely, labeling alcohol a “drug,” given the nasty connotations that word has been so carefully given, calls into question the presumptive innocence and innocuousness of drinking by responsible, non-alcoholic adults, and of the industry that supplies them, as it also supplies children, alcoholics, and those who become violent and imprudent under the influence of drink. To the analytically-minded it seems perverse that the one-eighth or so of diagnosable substance abuse disorder (other than nicotine dependency) that relates to the controlled drugs should receive much more attention (whether measured by rhetoric or control resources) than the seven-eighths in which the problem substance is alcohol.

Drug rape myth exposed as study reveals binge drinking is to blame

A sure to be controversial finding about date rape drug allegations in England. It's worth noting that this finding, if replicated in other countries, doesn't disprove the existence of date rape but does suggest that preventing binge drinking may be an important way to reduce date rape:

Doctors tested 75 women who claimed their drinks had been spiked by date rape drugs, not one tested positive

Women who claim to be victims of 'date-rape' drugs such as Rohypnol have in fact been rendered helpless by binge-drinking, says a study by doctors.

They found no evidence that any woman seeking help from emergency doctors because their drinks were allegedly spiked had actually been given these drugs.

Around one in five tested positive for recreational drugs while two-thirds had been drinking heavily.

The findings further erode the theory that there is widespread use of Rohypnol and GHB, another drug said to be favoured by predatory rapists.

Take Kids Away From Alcoholic Parents

Neil McKeganey, who's opinions I've tended to admire, has some strong words about intervening with alcoholic parents. I think I agree that there should not be disparity between drug addiction and alcohol addiction. However, I have real problems about any proposal to aggressively remove children from addicted parents. I think it's safe to assume that abuse or neglect is more common in an addicted home, but it seems to me that the same standards should be applied in all homes, addicted or not.

Alcoholic parents should have their kids taken from them in the same way as heroin addicts, one of Scotland's top addiction experts has claimed.

Professor Neil McKeganey, a former government adviser, has accused social services of double standards when dealing with heroin and alcohol addiction.

The respected academic has said children of parents who refuse to give up drink are suffering neglect as serious as those of drug addicts.

McKeganey, director of the Centre for Drug Misuse Research at Glasgow University, has warned the Scottish moralistic attitude to drugs means well-meaning social workers are failing thousands of Scots youngsters.

Social workers are often reluctant to remove children from the homes of alcoholics while the use of illegal drugs such as heroin is seen as far more serious.

Around 560 children are taken into care each year, the vast majority from parents who are drug addicts.

But as many as 100,000 children north of the Border are living in homes where alcohol abuse is affecting their welfare.

McKeganey believes alcohol problems result in more children being neglected.

It is feared a change in approach towards parental drink problems would see the beleaguered social services system swamped with cases.

But Professor McKeganey said alcoholism must now be treated in the same way as drug addiction in order to protect Scots children.

He said: "It is almost certainly the case that a child in a home with parental alcohol abuse is not being well looked after.

"If a parent cannot change their behaviour, they cannot be allowed to continue to harm their children.

"More should be removed from their homes, where parental alcohol use is affecting their health, than is currently the case.

"Social services are understandably extremely reluctant to remove children from the parental home. Often through a false sense of optimism they hope parents will resolve to start to look after their children.

"And yet that can often mean children remain within their families for far too long and suffer long-term harm as a result."

Here's a slightly more sober view:

Tom Wood, chairman of the Scottish Association of Alcohol and Drug Action, said: "We've been focused on the children of drug abusing parents, but children of alcohol abusing parents are as vulnerable.

"There are subtle differences between living in a home with an alcohol or drug problem but the same rules apply.

"Some cases will merit intervention - whether that is supervision in the home or, as a last resort, the child being taken into care.

"If you use drugs, bang, your child could be taken into care. But you can use alcohol. That's a moralistic view which I think is flawed."

The war on drugs, tobacco style

Here's an academic take from the perspective of an economist on the war on drugs. The post was inspired by an article about cigarette bans in prison driving prices to as high as $125 per pack.

Intensive care helps smokers quit, study finds

A new smoking cessation study finds promising long term outcomes:

An intensive stop-smoking program with at least three months of counseling and free drugs can help smokers kick the habit, U.S. researchers reported on Monday.

Their intensive care program helped 39 percent of smokers stay tobacco-free for two years, the team at Creighton University Cardiac Center in Omaha, Nebraska reported.

"What we have shown is that a very planned and organized approach to cessation of smoking, with careful follow-up, works much better than the current practice of simply advising them to quit smoking," said Dr. Syed Mohiuddin, who led the study.

The war within, killing ourselves

Lou Dobbs weighs in on the war on drugs:

We're fighting a war that is inflicting even greater casualties than the wars in Iraq and Afghanistan and, incredibly, costing even more money. We're losing the War on Drugs, and we've been in retreat for three decades.

That statement may come as a surprise to John Walters, Director of the White House Office of National Drug Control Policy, who spent last week trumpeting the Bush administration's anti-drug policies. He claims these policies have led to a decline in drug abuse and improvements in our physical and mental health.

While Walters focused on a marginal decline in drug use, he made no mention of the shocking rise in drug overdoses. The Centers for Disease Control and Prevention this week reported unintentional drug overdoses nearly doubled over the course of five years, rising from 11,155 in 1999 to 19,838 in 2004. Fatal drug overdoses in teenagers and young adults soared 113 percent.

More than 22 million Americans were classified with substance abuse or dependence problems in 2005, according to the Substance Abuse and Mental Health Services Administration. Nearly 8,000 people are trying drugs for the first time every day -- that's about 3 million a year. The majority of new users are younger than 18, and more than half of them are female.

Obviously, John Walters and I are not looking at the same statistics. There is simply no excuse for permitting the destruction of so many young lives.

How can anyone rationalize the fact that the United States, with only 4 percent of the world's population, consumes two-thirds of the world's illegal drugs?

Former President Richard Nixon first declared a modern-day war on the use of illicit substances, calling drugs "public enemy number one" and pushing through the Controlled Substances Act of 1970. Since then the government has waged a futile, three-decades-long war of attrition.

Illicit drug use costs the United States almost $200 billion a year, according to the National Institute on Drug Abuse. Include alcohol and tobacco-related costs along with health care, criminal justice and lost productivity and the figure exceeds $500 billion annually.

Even with new rehabilitation centers and clinics, less than 20 percent of drug and alcohol abusers receive the treatment they need and the cycle of drug-related crime continues unabated.

It's estimated about half of the more than two million inmates in our nation's prisons meet the clinical criteria for drug or alcohol dependence, and yet fewer than one-fifth of these offenders receive any kind of treatment. Studies show successful treatment cuts drug abuse in half, reduces criminal activity by as much 80 percent and reduces arrests by up to 64 percent.

As NIDA reports, "Treatment not only lowers recidivism rates, it is also cost-effective. It is estimated that for every dollar spent on addiction treatment programs, there is a $4 to $7 reduction in the cost of drug-related crimes. With some outpatient programs, total savings can exceed costs by a ratio of 12:1."

In the midst of the global war on terror along with wars in Iraq and Afghanistan, we have forgotten about the brutal effects of narcotics trafficking on millions of American lives. We must end the abuse of drugs and alcohol, and provide successful treatment for Americans whose addictions are destroying their own lives and wounding our families and society.

Whatever course we follow in prosecuting other wars, we must commit ourselves as members of this great society to only one option in the War on Drugs -- victory.

How many drinks is too many? | The Daily Telegraph

I've been in a couple discussions over the past few days about federal drinking guidelines and what constitutes risky drinking. It just happens that Australia is reviewing their drinking guidelines. Of special concern are pregnant women and young women. Their drinking guidelines for healthy people between 18 and 64 are as follows:

For men: No more than 4 Standard Drinks a day on average and no more than 6 Standard Drinks on any one day. One or two alcohol-free days per week.

For women: No more than 2 Standard Drinks a day on average and no more than 4 Standard Drinks on any one day. One or two alcohol-free days per week.

*These drinks should be spread over several hours. For example, men should have no more than 2 standard drinks in the first hour and 1 per hour after that. Women should have no more than 1 standard drink per hour.

Special report: Under-age drinking (U.K.)

Independent Online Edition >England is also experiencing problems with underage drinking. In England 18 year olds can purchase alcohol and 16 year olds can drink alcohol in s restaurant, if the alcohol was purchased by a parent.

Amid growing concerns over 24-hour drinking, soaring rates of liver disease and police forces unable to cope with drunken disturbances on the streets, an exclusive Independent on Sunday investigation today reveals the dramatic rise in children admitted to hospital because of alcohol-related illnesses.

The biggest increase is seen among girls under 16 years old, with a 25 per cent increase between 2002/03 and 2004/05. And the problem is getting worse: hospital admissions for under-18s are at their highest since records began, and the average amount children are drinking every week has doubled since 1990.

Professor Mark Bellis, director of the Centre for Public Health at Liverpool John Moores University and a government adviser on alcohol-related issues, said: "The numbers of underage drinkers in hospital for alcohol-related conditions are substantial but it is only the tip of the iceberg. Many more children are admitted for problems not recorded as alcohol. The admissions include everything from being involved in violence to teenage pregnancies. For every one youth admitted due to alcohol consumption there are many more whose health suffers through excessive alcohol consumption."

The ages of children admitted to hospital for alcohol-related problems are getting lower. The number of eight-year-old-boys who drink has doubled from 5 per cent in 1995 to 10 per cent in 2005. The number of 11-year-old girls who drink has increased from 15 per cent in 1995 to 25 per cent in 2005. Many experts believe country is in the grip of a hidden epidemic - one that, like alcoholics themselves, the country is in denial about.

...

Last year police introduced exclusion zones around the beaches of Polzeath and Rock after residents complained of underage drinking and fighting. Dubbed the "Costa del Sloane", the beaches are a magnet for children from public schools.

A senior policeman with Devon and Cornwall constabulary also spoke out about the underage drinking culture after a mob of 100 youths - some as young as 12 - were caught at a mass boozing session in Falmouth.

The startling rise in underage drinking is already beginning to have repercussions on public health and will continue to do so for future generations unless something is done to curb the alcohol consumption of British children, campaigners say.

Frank Soodeen of the charity Alcohol Concern said: "A recent government report on alcohol-related deaths showed that the biggest group was men and women aged 35-54 - which is far younger than ever before. Clearly it's beginning to catch up at an earlier stage, which is very worrying. Generally the highest proportion a few years ago was well above that age group."

The most serious of these health problems is liver cirrhosis. People in their 20s and 30s are now ending up with serious liver problems which, until recently, were normally seen in people twice those ages.

Professor Ian Gilmore, president of the Royal College of Physicians and a liver specialist at the Royal Liverpool Hospital, said: "Cirrhosis of the liver has increased tenfold since the 1970s. There is a big concern about the rise in deaths from cirrhosis among young people. I think we are going to see big increases in people in their 20s and 30s being diagnosed with liver cirrhosis."

David Mayer, chair of the UK Transplant Liver Advisory Group, warned that young drinkers are storing up a problem for the future and are likely to require his services in years to come. "People have more money and more opportunity to drink from an earlier age and therefore their livers are exposed to chronically high alcohol levels. We are concerned that it's becoming an epidemic. It does take many years to develop cirrhosis, but if you start drinking at an early age you are going to see problems sooner rather than later."

With such a marked increase in child drinking, campaigners are furious over the lack of provision offered to young people such as Hayley in helping to tackle their problems. There are even calls for drying-out clinics to be set up specially for young people.

But Professor Bellis argues that we need to help children long before it reaches that stage. "Waiting until children develop alcohol problems means their health, their education and ultimately their life prospects have already begun to suffer. We need a major shift in our national attitudes towards alcohol."

Caroline Flint, the public health minister, last week claimed that the Government is tackling the problem through "targeted enforcement" - reducing sales to under-18s by bars, off-licences and retailers - as well as education on substance abuse.

But campaigners blame the drinks industry for promoting alcohol as "sexy" to the young. Mr Soodeen said: "The drinks industry plays a big part in the whole issue. We really need to be cutting off the supply to young people. Unfortunately, the drinks industry has been very effective in persuading the Government that a 'voluntary health' approach is the way forward. We find it odd that so much of the packaging on alcopops seems juvenile and the alcohol industry has yet to come up with a credible explanation."

[via: Alcohol and Drugs History Society]

An Honest Conversation About Alcohol

From Inside Higher Ed:

Two months after he finished up as president of Middlebury College in 2004, John M. McCardell Jr. wrote a column for The New York Times called “What Your College President Didn’t Tell You.” In the piece, he discussed how he was “as guilty as any of my colleagues [as presidents] of failing to take bold positions on public matters that merit serious debate.” Taking advantage of his new emeritus status, he proceeded to take a few such positions. Among other things, he wrote that the 21-year-old drinking age is “bad social policy and terrible law,” and that it was having a bad impact on both students and colleges....

The current law, McCardell said in an interview Thursday, is a failure that forces college freshmen to hide their drinking — while colleges must simultaneously pretend that they have fixed students’ drinking problems and that students aren’t drinking. McCardell also argued that the law, by making it impossible for a 19-year-old to enjoy two beers over pizza in a restaurant, leads those 19-year-olds to consume instead in closed dorm rooms and fraternity basements where 2 beers are more likely to turn into 10, and no responsible person may be around to offer help or to stop someone from drinking too much.

I have a few brief reactions. First, I don't have a strong opinion on the matter, other than I'd be troubled by 18 year old high-school students being able to buy alcohol.

In principle, the general idea of a less restrictive drinking law might appeal to Libertarians, but drinking licenses? That'll lose Libertarian support fast.

He makes an argument about current law criminalizing parents who try to teach their kids to drink responsibly. First, is serving alcohol necessary to do this? Second, as we saw a few weeks ago, this isn't illegal in 31 states. Third, when is the last time you heard of parents fined or arrested for allowing their teen to have a glass of wine with dinner?

Some of his arguments are a stretch -- for example, using SAMHSA's increased attention to underage drinking as an argument against the existing policy and implying that there's a relationship between the 21 year old drinking law and younger ages of first use.

The fact that we currently have problems, isn't necessarily a good argument against the status quo. Anyone who's honest with themselves will recognize that there is no such thing as a problem-free drug and alcohol policy. As I've said before in this blog, these drug policy questions are all about trade offs and, recognizing that every policy requires living with some problems, the questions you have to wrestle with are:

• Which problems are intolerable and which are you willing to tolerate?
• How do you make these decisions? (I'd suggest that even responses that purport to be value-free are value laden.)
• Which policy (or combination of policies) best balances these values?

It seems like these discussions would generate more light if people were a little more honest in acknowledging the problems inherent in their pet theory.

Drugs, Brains, and Behavior: The Science of Addiction

From NIDA:

"Drugs, Brains, and Behavior: The Science of Addiction" was unveiled today by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health. The 30-page full-color booklet explains in layman's terms how science has revolutionized the understanding of drug addiction as a brain disease that affects behavior. NIDA hopes this new publication will help reduce stigma against addictive disorders.

"Thanks to science, our views and our responses to drug abuse have changed dramatically, but many people today still do not understand why people become addicted to drugs or how drugs change the brain to foster compulsive drug abuse," said NIDA Director Dr. Nora D. Volkow. "This booklet aims to fill that knowledge gap by providing scientific information about the disease of drug addiction in language that is easily understandable to the public."

The "Science of Addiction" booklet discusses the reasons people take drugs, why some people become addicted while others do not, how drugs work in the brain, and how addiction can be prevented and treated. Like diabetes, asthma or heart disease, drug addiction is a chronic disease that can be managed successfully. Treatment helps to counteract addiction's powerful disruptive effects and helps people regain control of their lives. The new booklet points out that just as with other chronic diseases, relapses can happen. The publication further explains that relapse is not a signal of treatment failure - rather, it indicates that treatment should be reinstated or adjusted to help the addict fully recover.

A Toxic Brew

Psychology Today has an article on ACOAs. Something I haven't seen in a while:

If alcoholism seems like a lot to handle, imagine growing up with addicted parents. The alcoholic family is one of chaos, inconsistency, unclear roles, and illogical thinking. Arguments are pervasive, and violence or even incest may play a role. Children in alcoholic families suffer trauma as acute as soldiers in combat; they also carry the trauma like an albatross throughout their lives....

Tobacco, tobacco tobacco

Three recent articles on tobacco. First, The Boston Globe reports on the effectiveness of pharmacological treatments for nicotine addiction. The article presents a pretty pharmacological treatments as an essential part of a smoking cessation plan.

Philip Quartier, a 64-year-old stockbroker from Mission Hill, had been smoking a pack of cigarettes a day for 45 years when he quit for the first time. After five clean years, an impulse led him to pick up another cigarette eight months ago, and the biking enthusiast, who has lung disease, was frustrated to be back to his old habit.

Determined to quit for good, he dug out the subliminal motivation tapes he'd used the first time around, went back on the nicotine patch, bought a self-help book, and joined a counseling group, but several months into the process, he was getting nowhere. So in November, he got a prescription for Chantix (varenicline), a six-month-old drug that is the first new quit-smoking treatment in a decade.

The pills don't work for everyone but quickly diminished Quartier's cravings. "By the eighth day I was absolutely ready" to give cigarettes up again, he said.

Though most smokers try to quit without help, nicotine-free treatments including Chantix and longtime staples like nicotine gum and patches are more effective than trying to quit "cold turkey," according to experts and research.

Next, Dr. Wes questions the federal push toward pharmacological treatments and provides some compelling arguments:

Well it seems that nicotine patches are now part of the federal guidelines regarding smoking cessation issued by the Public Health Service, a division of the Department of Health and Human Services. But an interesting twist to these guidelines was revealed yesterday (WSJ, subscription):

(Doctor) Michael Fiore is in charge of revising federal guidelines on how to get smokers to quit. He also runs an academic research center funded in part by drug companies that make quit-smoking aids, and he personally has received tens of thousands of dollars in speaking and consulting fees from those companies. ... Dr. Fiore, a University of Wisconsin professor of medicine, headed the 18-member panel that created those guidelines. He and at least eight others on it had ties to the makers of stop-smoking products.

Those opposed to urging medication on most quitters note that cold turkey is the method used by the vast majority of former smokers. They fear the federal government's campaign could discourage potential quitters who don't want to spend money on quitting aids or don't like the idea of treating their nicotine addiction with more nicotine.

"To imply that medications are the only way is inappropriate," says Lois Biener, a senior research fellow at the University of Massachusetts at Boston who has surveyed former smokers in her state. "Most people don't want them. Most of the people who do quit successfully do so without them."

What is interesting is the way the government makes these recommendations: based on clinical trials. And who is better equipped to perform clinical trials than drug companies? (Bias 1). Further, all of the individuals in clinical trials must sign consent, and therefore have to be willing to take a drug (Bias 2). So these "clinical trials" are, by their very nature, skewed toward those willing to take a drug.

But in the interest of revealing effectiveness of these smoking cessation drugs in the real world, another type of study, an observational population trial that looks at all comers to the smoking cessation party, found this:

Studies of quitters outside clinical trials have shown no consistent advantage for medicine over cold turkey, the pharmaceutical industry's primary competitor. An unpublished National Cancer Institute survey of 8,200 people who tried quitting found that at three months, users of the nicotine patch and users of bupropion (Wellbutrin) remained abstinent at higher rates than did users of no medication. But at nine months, the no-medication group held an advantage over every category of stop-smoking medicine. The study was presented at a world tobacco conference last summer.

Finally, a recent Biological Psychiatry commentary addresses the links between alcohol and nicotine addiction, including the genetic links, shared neurobiological mechanisms, shared behaviors and treatment.

Epidemiologic data confirm that: (1) heavy drinking may stimulate smoking; (2) cessation of smoking may enhance abstinence from alcohol; and (3) combined treatment for dual addiction may achieve the most beneficial treatment outcome.

Teen drinking laws update

A couple of weeks ago I posted about laws that allow teens to drink with their parents and asked for info on Michigan law. Brian, a student of mine who is also a juvenile probation officer sent this:

I checked into the laws governing underage drinking related to parents here at the courthouse. There are no laws that allow for parents to let their kids drink in any circumstance. However, there are limited exceptions. One is allowed for religious purposes in a religious setting. Another is for educational purposes like in a culinary class for cooking. If a parent provides or allows a kid to drink they can be charged with contributing to the delinquency of a minor or furnishing alcohol to a minor.

Thanks Brian!

Charity records 13% rise in post-Christmas abortions

A publicity seeking stunt? Or, a little mentioned harm associated with excessive drinking?

The family planning service Marie Stopes International said today that it performed a record number of UK abortions last month.

The charity carried out nearly 6,000 abortions at its nine centres across the UK in January, the highest number in its 32-year history. This was a rise of 13% on January last year.

The charity's UK director, Liz Davies, blamed the surge in abortions on excess drinking over the Christmas season.

[Hat tip: New Recovery]

Three takes on weed

First, USA Today did it's best to create the impression that there is still a raging debate about marijuana and the gateway theory:

Most users of more addictive drugs, such as cocaine or heroin, started with marijuana, scientists say, and the earlier they started, the greater their risk of becoming addicted.

Many studies have documented a link between smoking marijuana and the later use of "harder" drugs such as heroin and cocaine, but that doesn't necessarily mean marijuana causes addiction to harder drugs.

"Is marijuana a gateway drug? That question has been debated since the time I was in college in the 1960s and is still being debated today," says Harvard University psychiatrist Harrison Pope, director of the Biological Psychiatry Laboratory at Boston's McLean Hospital. "There's just no way scientifically to end that argument one way or the other."

That's because it's impossible to separate marijuana from the environment in which it is smoked, short of randomly assigning people to either smoke pot or abstain — a trial that would be grossly unethical to conduct.

"I would bet you that people who start smoking marijuana earlier are more likely to get into using other drugs," Pope says. Perhaps people who are predisposed to using a variety of drugs start smoking marijuana earlier than others do, he says.

Besides alcohol, often the first drug adolescents abuse, marijuana may simply be the most accessible and least scary choice for a novice susceptible to drug addiction, says Virginia Tech psychologist Bob Stephens.

No matter which side you take in the debate over whether marijuana is a "gateway" to other illicit drugs, you can't argue with "indisputable data" showing that smoking pot affects neuropsychological functioning, such as hand-eye coordination, reaction time and memory, says H. Westley Clark, director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration.

The article ends up hedging its bets and qualifies just about everything she says. I find it hard to argue with the facts presented, but the emphasis and the selective inclusion suggest that the writer might be guilty of hype.

Next, a Canadian publication advocates legalizing and regulating marijuana:

Because of crimes that are related to the drug trade—most notably the killing of the four police officers in Mayerthorpe two years ago—many have been pushing for increased punishment for drug-related crimes recently. While a tactic such as increased jail time would theoretically make criminals think twice before becoming involved in the trade, there’s no statistical evidence that supports this claim.

The fact remains that it’s just too profitable an industry to be deterred by harsher punishment. Instead we need to end this failed experiment called prohibition and regulate most, if not all, drugs.

...The regulated sale of drugs would mean that one of the biggest dangers of drug use, drugs that are laced with more dangerous substances, would be systematically eliminated. As well, it would allow people to find a more accurate description of what they are taking, what it does to them, recommended doses and possible negative side effects. A more honest approach on the effect of these drugs would work better than just saying that drugs kill.

If there’s a demand for illicit drugs, like any other product, why should criminal elements be the ones who profit from it? Marijuana, for example, is more profitable than any other crop in Canada. Instead of letting criminals sell it, using the profits for other nefarious purposes, why doesn’t the Canadian government make it and sell it, eliminating the criminal element in the process? People are still going to buy it either way, after all.

Variations of this proposal a published frequently. At least this version eliminates profit potential. Most versions of this proposal suggest legalizing and regulating private sale, which raises the specter of a marijuana industry with the promotional and lobbying power of the alcohol and tobacco industries. While all variations of legalization models have an uphill battle, one that puts the government in the role of manufacturer and sales seems DOA.

Finally, STATS was riled by the USA Today article. They make several strong rebuttals to the points in the USA Today - if there is a gateway drug it's alcohol; alcohol causes more harm; there's lots of evidence against the gateway theory; most marijuana users experience little or no harm, etc. However, she also inserts her bias and misrepresents the USA Today article:

So, where’s the evidence that marijuana is more harmful than other substances?

The USA Today article didn't argue that marijuana is more harmful, just that it's not harmless. There were enough problems with the article that the straw man tactics we're needed.

Ultra Abstinence Approach?

I'm glad I'm not a drug addict in Ireland:

Two doctors specialising in treating substance abuse in Dublin have called for new thinking in treatment services and say doctors need to be aware that the evidence-base shows that abstinence in opiate drug addiction treatment does not work.

...Dr Quig­ley believes some doctors take an “ultra abstinence approach” which doesn’t necessarily work in drug addiction.

Says Dr Quigley: “As we have gone along with the metha­done programme we have abandoned some previous processes like attempting to pressure addicts to detox. On the basis of medical evidence, that just doesn’t work and creates more difficulties.”

Dr McGovern supports this view: “Unfortunately, evidence doesn’t support this [abstinence] approach and very few would remain free of opiates, and with any illicit substance, relapse is the norm.”

Both doctors say most general adult psychiatrists seem to advocate an abstinence ap­proach for opioids, and say the historical approach of abstinence and Alcoholics Anony­mous for alcoholism simply does not work in drug addiction treatment. “If you bring that sort of thinking in automatically into drug addiction, you are liable to get it wrong. You have to leave that approach outside the door of the surgery,” Dr Quigley adds. He also expresses concern about the abstinence ap­proach taken by the country’s forensic psychiatry services. “The Central Mental Hospital is strongly abstinent in orientation and that is where the problem arises with retaining dangerous addicts in treatment,” says Dr Quigley.

If that doesn't convince you that they've got an addiction stigma problem, it appears that they have a problem finding treatment for all of the violent drug addicts:

While there is a debate over whether patients who are violent should be excluded from treatment, either for a period, or for good, Dr McGovern says he believes that the patients who are violent are the very ones who most need treatment.

Both doctors believe the lack of services in which to refer violent patients on to is a major flaw in the system.

Dr Quigley adds: “Some people threaten the medical staff, and smash our vehicles or assault us. If they manifest that, we have to be able to pick up the phone [to the central treatment centre in Trinity Court]. If you can’t say that, and have to say ‘you’re barred from the clinic,’ you’re likely to be assaulted personally.”

Dr McGovern calls for better training for staff in dealing with violence. “Such patients need to be treated in a unit that is safe for both staff and other patients. The unit needs to be staffed by professionals who have specialist forensic psychiatric experience. I also believe that treating patients in a secure unit is only half the battle. Patients need to be offered treatment that ad­dresses aggressive behaviour.”

But often, no help is available to violent drinkers, says Dr Quigley. “They are getting no help because the addiction services that exist are not attractive to them, they are too rigid and not geared to people who are still drinking,” adds Dr Quigley.

While working in an agency that's treated over 10,000 of the poorest and most severely addicted people in our region, this has never been more than a rare problem.

Meth Addicts Demand Government Address Nation's Growing Spider Menace

From the Onion:

Following the tragic falling death of 32-year-old methamphetamine addict Phillip Diggs, who was reportedly attacked by spiders while scaling a large construction crane near Palo Alto, CA, thousands of outraged and confused meth addicts marched frenetically on Washington as part of a week of activities urging the federal government to address the nation's growing spider epidemic.

"Something needs to be done and it needs to be done soon—these spiders are everywhere," said Rich Harlowe, event organizer and founder of Tweakers' Rights NowNowNowNowNowNowNowNowNow!, in testimony before a Senate committee Tuesday. "The government must address this problem before the situation gets out of hand and these poisonous, acid-shooting spiders develop the powers of mind control or—God forbid—flight."

"America cannot afford to ignore this any crisis any longer," Harlowe added.

The rally drew addicts from every part of the country, many traveling on foot through the night, trading sex with truck drivers for rides, or stealing their brothers-in-law's bicycles. At dozens of rambling public speeches, organizers decried the fact that it took the spider-related death of an innocent meth addict to raise awareness of the issue, while lauding the bravery of meth addicts, and methamphetamines themselves.

A 45,000-word proposal was drafted by members of TRN during a marathon, 72-hour meeting under the Roosevelt Bridge, and presented twice to the Senate Indian Affairs Committee. The document, which includes schematics for the development of a giant "spider bomb" the size of Rhode Island, concludes repeatedly that the problem would best be combated with large quantities of methamphetamines and steel wool.
Meth Addicts Jump

"This very morning, I saw a small child completely covered in hairy, bloodsucking, screaming tarantulas while his parents stood by and did nothing," said protester Joe Lopez, pausing to spit out a black and decayed tooth. "I was appalled. I shouted horrible profanities and incantations at them, but they ignored me."

"I, I, I don't—this is just, just, just—I, I, I—guh, ah," he added.

A Small Part of the Brain, and Its Profound Effects

More on the insula and nicotine addiction. (Requires free registration. If you don't wish to register, you can use www.bugmenot.com.)

According to neuroscientists who study it, the insula is a long-neglected brain region that has emerged as crucial to understanding what it feels like to be human.

They say it is the wellspring of social emotions, things like lust and disgust, pride and humiliation, guilt and atonement. It helps give rise to moral intuition, empathy and the capacity to respond emotionally to music.

Its anatomy and evolution shed light on the profound differences between humans and other animals.

The insula also reads body states like hunger and craving and helps push people into reaching for the next sandwich, cigarette or line of cocaine. So insula research offers new ways to think about treating drug addiction, alcoholism, anxiety and eating disorders.

Of course, so much about the brain remains to be discovered that the insula’s role may be a minor character in the play of the human mind. It is just now coming on stage.

The activity of the insula in so many areas is something of a puzzle. “People have had a hard time conceptualizing what the insula does,” said Dr. Martin Paulus, a psychiatrist at the University of California, San Diego.

If it does everything, what exactly is it that it does?

For example, the insula “lights up” in brain scans when people crave drugs, feel pain, anticipate pain, empathize with others, listen to jokes, see disgust on someone’s face, are shunned in a social settings, listen to music, decide not to buy an item, see someone cheat and decide to punish them, and determine degrees of preference while eating chocolate.

Damage to the insula can lead to apathy, loss of libido and an inability to tell fresh food from rotten.

Plan to vaccinate babies against drugs

The U.K.'s Daily Mail recently ran a story on a plan to vaccinate children for cocaine, heroin and tobacco. The vaccine would prevent any effects from the drugs and therefore prevent any addiction.

A group called the Transform Drug Policy Foundation has written a response on their blog. They argue that: Drug vaccines don’t really work; Giving drug vaccines to children is profoundly unethical; Even if vaccines worked it wouldn’t prevent problematic drug use, or offending.

I find it pretty unlikely that there would be any significant steps in this direction in the near future. I think it's far more likely that drugs like this will be tried with people who have developed problems before their used in preventative strategies.

Pseudophedrine restrictions a boon to Mexican cartels

Recent efforts may have been successful at reducing American meth production, but it appears Mexican cartels may be picking up the slack.

The Combat Methamphetamine Act of 2005, which trumps laws that had already been passed in many states, made stores move their cold medicines containing the decongestant pseudoephedrine - which can be extracted and used to make methamphetamine - behind the counter, limit the amount that consumers can purchase and require purchasers to present photo identification. Stores must also keep personal information about these customers in a logbook for two years.
The regulations lend an illicit air to a legitimate attempt to banish a stuffy nose. Many cold meds now include phenylephrine, which doesn't carry the same restrictions - or efficacy....

But if consumers view this new counter ritual as a small sacrifice to keep meth off the streets, they may be disappointed to see that tough restrictions at the drugstore have failed to dent availability of the illegal drug. Restricting pseudoephedrine may have shut down small-time neighborhood meth cookeries, but Mexican cartels have seized the opportunity to swoop into unconquered territory and make those meth customers their own.

According to the National Drug Intelligence Center's 2007 National Drug Threat Assessment, "Marked success in decreasing domestic methamphetamine production through law enforcement pressure and strong precursor chemical sales restrictions has enabled Mexican (drug trafficking organizations) to rapidly expand their control over methamphetamine distribution - even in eastern states - as users and distributors who previously produced the drug have sought new, consistent sources."
Additionally, the flow of "ice" - highly concentrated meth that is usually smoked - from Mexico has increased sharply, most likely creating more addicts because of the better high it creates, states the report.

So while lawmakers have focused on regulating sniffling customers at drugstore counters, Mexican cartels have monopolized the gaps left in the meth market, bringing their goods - and guns - across a porous border. "Now, approximately 80 percent of all meth purchased in the U.S. originates from Mexican labs,"

This has gotten some attention on some blogs, but feels like they're trying to have it both ways: "Look! The boneheaded drug warriors have created a crisis. They've given a gift to those vicious Mexican drug cartels, who are invading thanks to our porous borders."; and "Look! The boneheaded drug warriors are hyping meth use. There's no crisis and there never was!"

This particular columnist is politically conservative and has previously written at least a few articles on immigration. Is this just an opportunity to raise alarm at illegal immigration?

About That Methedemic

Jack Shafer gives Newsweek a big TOLD YA SO!

Last Friday, Jan. 26, the federal National Survey on Drug Use and Health released results from a survey that showed meth use had "declined overall between 2002 and 2005" and that the number of "initiates"— people using the drug for the first time in the 12 months before the survey—had "remained relatively stable between 2002 and 2004, but decreased between 2004 and 2005."

Homelessness a cause, not a result of drug abuse

This article has gotten a lot of attention today. It runs counter to my admittedly biased experience and the experience of colleague who work in settings focused on homelessness. Note that it uses the term substance abuse rather than dependence. It's easy to believe that people with a diagnosis of substance abuse may have developed problems after becoming homeless. I find it more difficult to believe that people with substance dependence would have developed their problem only after becoming homeless.

It will be interesting to see the actual report and analysis of it:

A report on homelessness in Melbourne has shattered two key myths: that substance abuse and mental illness are the major reasons why people become homeless....

About 43 per cent had problems with substance use while 30 per cent reported mental health problems. Of these, 66 per cent and 53 per cent respectively had developed the problems after becoming homeless.

Activists Plan 'Safe Site' for Drug Smokers

Another article on calls for a "safe inhalation site" in Vancouver:

Addicts who smoke hard drugs will have an indoor place to get their fix if a Vancouver drug users group is able to open North America's first safe inhalation site later this year....

Such an unsanctioned facility would provide a supervised location for addicts to smoke crack cocaine and heroin, in much the same way that Insite -- Vancouver's legally sanctioned three-year-old safe injection site -- provides services to addicts who inject the same drugs.