S.F. injection center idea draws, support and doubt

San Francisco mulls Vancouver's experience.

Highlight:

"It's really been studied to death - it's time to move on," Kerr said. "It's obvious this is something that works."

I suppose it depends on your definition of "works." More here.

Too much cannabis 'worsens pain'

More isn't always better:

The pain-relieving qualities of cannabis have long been hailed, and several countries have made it available for medicinal purposes.

But quantity is key, according to the study in the journal Anesthesiology.

...those who had smoked the moderate dose said their pain was much better, while those who consumed high doses said it had got worse.

They did, however, feel "higher" than counterparts who had taken moderate doses.

Neurobiology of alcohol craving

I've seen several MRI studies of cocaine cravings, but I don't remember seeing the same for alcohol:

Aims: This study's purpose was to identify the neural substrates and mechanisms responsible for craving among subjects with alcohol use disorders (AUDs) using functional magnetic resonance imaging (fMRI). Methods: Alcohol abusers with AUD (n = 9) and demographically similar non-abusers (n = 9) participated in this study. After given 5 cc of alcohol, subjects were exposed to different types of stimuli [i.e. alcohol, non-alcoholic beverage, and visual control pictures and one rest (cross-hair)]. Craving levels were rated through self-report on a Likert scale immediately after the presentation of visual cues. Results: Brain activations in the fusiform gyri, temporal gyri, parahipocampal gyrus, uncus, frontal gyri, and precuneus were correlated with the level of craving among subjects with AUD in response to alcohol cues. Conclusions: In conclusion, specific brain regions were identified that are associated with craving among subjects with AUD.

Needle exchange an unmitigated disaster

The Victoria Times Colonist recently published a description of what it's like to live near a needle exchange. Not to sound too cocky, but HR programs like this could do themselves a favor by reading and thinking about our position paper on HR. (Value number 5, in particular.)

Child killings challenge the drug war

Nolan Finley takes on the drug war:

You want to know why kids are being killed in Detroit? Because drug dealing is a $100 billion enterprise in the United States. All of that money moves through the criminal underground, where it is untaxed, unregulated and untraceable.

The only way to stop the drug trade from consuming our children and our communities is to take the profit out of selling dope.

For more than 30 years, we've tried to do that by kicking in doors, rounding up street corner dealers, cutting off international supply lines and filling our prisons. And it hasn't worked.

It will never work. Those determined to destroy themselves with drugs will find a way to do so, just as those who prefer to ruin their lives with alcohol or gambling, vices the government decided that, if we can't beat 'em, we might as well tax 'em.

So let's get the drugs off the street and into the pharmacies where they belong. Pick a variety of narcotics, from marijuana to heroin, and sell them in measured doses over-the-counter, like packaged liquor.

Move the drug money from the alleys to Wall Street. Let the pharmaceutical companies produce, sell and pay taxes on narcotics.

Perhaps we'll have more users when drugs are no longer illegal. But legalizing drugs will allow rehabilitation resources to be focused on those who truly have a problem, and create more funding for anti-drug education.

A drug-free America is an impossible dream. Our stubborn determination to press this lost cause is killing people.

If it were just the dope dealers who were dying, I'd say have at it. That's addition by subtraction.

But in Detroit we've seen the collateral damage of this misguided war.

When babies die in their beds, we have to start challenging the premises of the drug war, and asking whether the fight is worth the cost.

I've addressed these arguments before. (Imagine the power of the pharmaceutical, tobacco and alcohol industries being invested in legal opiates, cocaine and marijuana. Imagine what new drugs and methods of administration could be developed in corporate R & D departments.)

Why does this have to be a choice between the war on drugs and legalization? It doesn't.

Narcan handouts

The Boston Herald ran an article on a local Narcan handout program. Highlights:

Advertising with the glib phrase “Got Narcan? Need a refill?” plastered on the side of its needle exchange vans, the Boston Public Health Commission is stuffing the pockets of Hub junkies with the powerful prescription drug in hopes of countering heroin overdoses.

But front-line ambulance workers said giving addicts a powerful overdose remedy is a flat-out “stupid” practice that encourages uninhibited drug use and could even endanger their lives.

“The solution is for a health care professional to administer the drug, then offer them detox. These days you don’t know if the heroin is laced with something that can interact with it,” said Matt Carty, head of the Boston Police Patrolman’s Union/EMS Division. “It’s stupid, and you can quote me on that.”

The Public Health Commission, which oversees the emergency medical service, reports that since it began distributing Narcan a year ago, the drug has saved 50 addicts from overdoses.

Dr. Peter Moyer, the commission’s medical director, said the bottom line is that Narcan saves lives. It also keeps addicts returning to the city for services and counseling so that one day perhaps the addict will want to get off drugs, Moyer added.

“There’s really no downside to its use,” Moyer said. “They (addicts) do get training.”

What makes me nuts is not so much that they are handing our Narcan. It's that it's done in the context of no access to meaningful to treatment or recovery support services.

Sorting out protective and risk factors

Here's a study highlights how little we know about protective and risk factors:

The risky drinkers reported only slightly higher prevalence of experiencing child abuse or witnessing domestic violence compared to their non-risky drinking counterparts (see Table 1). However, those recruits who reported first drinking around 13 years were 5.5 times more likely to engage in riskier drinking behavior than recruits who reported first drinking after age 13. Other significant and anticipated predictors of young adult drinking were smoking, having a rural or small town background, having grown up with someone who was a problem drinker or having grown up with someone who suffered from mental illness. Some unexpected correlates of risky drinking were achieving a higher educational level, having more close family members or friends, and being raised by two parents.

...Young et al. (2006) provide support for the importance of age of onset to young adult drinking habits; however, they did not find adverse childhood experiences to be equally strong predictors of young adult drinking. Interestingly Young et al. (2006) noted that they did not expect to find that risky drinkers had a number of experiences that one might expect to be protective, such as, a higher number of close family and friends, a higher level of education, along with being slightly more likely to be raised by two parents. Young et al’s (2006) research shows that multiple and interactive factors, whether prototypically protective or detrimental, can be associated with harmful drinking behavior. The presence of protective childhood experiences does not guarantee a young adult life without substance abuse problems.

Technorati Tags: alcohol prevention abuse adolescent

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A tale of two cities...

Two recent articles about harm reduction plans in two cities.

I have lots of thoughts, but here's one quick one about the San Francisco story. Placing an injection center in the area with the highest OD rates seems obvious. But, would such a program (As opposed to a recovery oriented program.) further institutionalize addiction in this struggling community? Also, I've heard that the Tenderloin district is becoming gentrified. What might this do to plans for an injection center? What does that say about treatment of socio-economic classes?

Rethinking confrontation

I posted on this when it came out, but Bill White and Bill Miller recently published an article on confrontation that was just made available on the Counselor Magazine website. It makes a terrific point on confrontation as a therapeutic goal in contrast to confrontation as a therapeutic style:

In its etymology, the word “confront” literally means “to come face to face.” In this sense, confronting is a therapeutic goal rather than a counseling style: to help clients come face to face with their present situation; reflect on it; and decide what to do about it. Once confronting is understood as a goal, then the question becomes how best to achieve it. Getting in a person’s face is rarely the best way to help them open up to new perspectives. There is, as Hazelden observed in its 1985 recanting of aggressive confrontation, “a better way.” People are most able and likely to re-evaluate reality within safe, empathic, supportive and nonjudgmental interpersonal relationships that do not necessitate defensiveness.

One unrelated thought...what is up with the photos that Counselor chooses? Is it just me, or do they make addicts look like dangerous, crazy and volatile psychopaths?

"war on drugs"

The first time the New York Times used the phrase "war on drugs":

June 14, 1919

Health Commissioner Copeland Defends His War On Drugs
According to a statement given out yesterday by the Bureau of Narcotic Research, representing in its membership a number of philanthropists and medical men interested in the drug problem…the question that is interesting the doctors is how far the municipal and State authorities are seeking to interfere with the private practitioner’s efforts in curing drug addicts. Any amendments to the sanitary code as have been proposed that will aim to treat as a single class the thousands of persons addicted to the use of narcotics will be vigorously resisted by the doctors, says the bureau’s statement.

It also states that, according to figures compiled by the Police Department, there are at present some 250,000 addicts in New York. Of this number only about 15 percent are of the criminal or underworld classes, it says, and 212,500 of the total are making every effort to be cured.

via Mental Floss

Amsterdam's Magic Mushroom Tourists May Trip on Sales Crackdown

Drug tourists may be losing a destination:

Paul arrived in Amsterdam looking forward to a weekend with his friends. Instead, the 24-year-old Australian stayed holed up in his hotel room, too frightened to walk the streets after taking magic mushrooms.

"We had to lock ourselves up in case we would do something crazy,'' said Paul, who asked that his last name not be used because he didn't want acquaintances to know about his drug use. "There is no way this should be legal.''

In Amsterdam, where the fungi are sold in so-called smart shops, local officials agree. The city council last month approved a three-day waiting period to cut down on tourist use. The national government is considering an outright ban after a French teenager leapt to her death in March. Health Minister Ab Klink will release a statement on the hallucinogens this week.

Technorati Tags: drugs, policy, europe, legalization, hallucinogens

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Helping other alcoholics in alcoholics anonymous and drinking outcomes

This isn't a new article, but seemed worth sharing. Researchers demonstrate what mutual aid groups have known for decades. Helping other alcoholics helps the helper stay sober.

OBJECTIVE: Although Alcoholics Anonymous (AA) is the largest mutual-help organization for alcoholics in the world, its specific mechanisms that mobilize and sustain behavior change are poorly understood. The purpose of this study is to examine prospectively the relationship between helping other alcoholics and relapse in the year following treatment for alcohol use disorders. METHOD: Data were derived from Project MATCH, a longitudinal prospective investigation of the efficacy of three behavioral treatments for alcohol abuse and dependence. Kaplan-Meier survival estimates were used to calculate probabilities of time to alcohol relapse. To identify the unique value of helping other alcoholics when controlling for the number of AA meetings attended, proportional hazards regressions were conducted to determine whether the likelihood of relapse was lower for those who were helping other alcoholics. RESULTS: There were no demographic differences that distinguished participants in regard to involvement in helping other alcoholics, with the exception of age; those who were helping other alcoholics were, on average, 3 years older than those who were not helping alcoholics. Those who were helping were significantly less likely to relapse in the year following treatment, independent of the number of AA meetings attended. CONCLUSIONS: These findings provide compelling evidence that recovering alcoholics who help other alcoholics maintain long-term sobriety following formal treatment are themselves better able to maintain their own sobriety. Clinicians who treat persons with substance abuse disorders should encourage their clients to help other recovering alcoholics to stay sober.

It would be interesting to look at two more things:

• If these finding hold up in other mutual aid groups. I suspect they would.
• We know that mutual aid group involvement is a better predictor of recovery than attendance. 12 step work is frequently identified as an indicator of involvement. It would be interesting to see if the benefits of helping are are different or more powerful than other forms of mutual aid group involvement.
  

Technorati tags: recovery, alcoholism, aa, mutual_aid, research, addiction

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Europe: Curing, not punishing, addicts

This Op-Ed is a little simplistic, but does a decent job illuminating the difference in approaches. However, I find the headline to be the most striking thing about it. The problem I have with drug policy in some European countries isn't their lack of enforcement, it's the overemphasis on maintenance and harm reduction. Curing, as the headline suggests, does not appear to be a goal at all.

via dailydose.net

Technorati Tags: policy, harm_reduction, drugs, america, europe, addiction, drugs

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Five Myths About Crack

A Washington Post Op-Ed contributor offers some guidance to the supreme court in the form of 5 myths about crack:

1. Crack is different than cocaine.
2. Crack is instantly and inevitably addicting.
3. The "plague" of crack use spread quickly into all sectors of society.
4. Crack is the direct cause of violent crime.
5. Harsh sentences for crack are necessary to deter "serious" and "major traffickers."

Technorati Tags: cocaine, crack, policy, criminalization, addiction

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Seizure Drug May Treat Alcoholism

Topiramate has been used to treat alcoholism for a little while now and was featured in the HBO Addiction series. This story has been very widely reported over the last few days. It may become a useful tool for a small number of alcoholics, but I find the results reported in this article pretty underwhelming:

Compared with placebo treatment, treatment with Topamax was associated with an 8 percent greater reduction in the percentage of heavy drinking days during the trial, the researchers reported.

Researcher Bankole Johnson, MD, tells WebMD that alcoholics in the trial who took Topamax went from the equivalent of drinking a bottle and a half of wine a day to about 3 1/2 glasses of wine.

"I think that is a big difference," he says. "Most people can manage that amount of alcohol without getting into too much trouble."

The researchers reported that Topamax users had a greater rate of achieving 28 or more days of continuous nonheavy drinking during the study and 28 days of continuous abstinence.

The manufacturer has also been accused of promoting off-label use:

But in a letter to the FDA, the consumer interest group Public Citizen accused the company of illegally promoting use of the drug for this purpose.

While doctors can legally prescribe FDA-approved drugs for nonapproved conditions, it is illegal for the companies that market the drugs to promote these so-called "off label" uses.

The Public Citizen complaint involved a question-and-answer sheet distributed to the media before publication of the study, which specifically discussed the drug's potential "off label" use for alcohol dependence.

Kara Russell of Ortho-McNeill tells WebMD that the company knew nothing about the question-and-answer sheet until the Public Citizen letter became public."

Ortho-McNeil Neurologics does not support any reference to off label use of its products and only promotes the use of Topamax in the approved indication of migraine and epilepsy treatment," Russell says.

I'm not surprised. I've wondered what arrangement led to the prominent placement of topiramate in the HBO series. It was practically an infomercial and led the lay people I know to grossly overestimate the effectiveness of the drug.




Technorati Tags: topiramate, addiction, alcoholism, treatment, research, medication

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More on the new Canadian drug plan

65% for prevention and treatment (including culturally specific treatment) doesn't exactly sound Draconian:

The Conservative government's new $63.8-million, two-year drug strategy could be worse, but it could be better.Fully half the money will go toward beefing up treatment for addicts. Since health and social services are mainly a provincial responsibility, however, that money will go mainly to development of national benchmarking - so that evaluations can be consistent across the country - and extra programs for aboriginals. The main burden of helping addicts remains with the provinces.Another $10 million will go to prevention - ad campaigns and brochures to remind people, especially young people, how damaging addiction is. "Drugs are dangerous and destructive," Prime Minister Stephen Harper said, unveiling the plan. "If drugs do get hold of you, there will be help to get you off them."

Based on American experience, mandatory minimum sentences don't seem like a wise move, but why not start lobbying and negotiating instead of calling them idiots.


Technorati Tags: canada, addiction, treatment, prevention, policy

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Cash for safe drug injection "off mark"

How about getting these people into treatment? Do they have waiting lists for treatment in Australia?

...Jann Stuckey said the Queensland Injectors Health Network was distributing flyers headed: "Wanna make some cash?"

They offered $110 cash payments to intravenous drug users willing to teach others safe injecting techniques, or, "learn a bit, share a bit and make a bit".

Ms Stuckey said it was not a responsible way to deliver a harm minimisation program.

"To pay drug addicts in this manner, knowing that the $110 will almost certainly be their next hit, is grossly irresponsible," she told reporters on Tuesday.

Ms Stuckey said she believed the program was not effective because it did not focus on getting people off drugs.

"Without that support, these facilities are nothing more than needle hand-outs," she said.

"The public have for many years been led to believe these are needle exchanges, and sadly, this is not true."

Premier Anna Bligh said Queensland Health had ordered the advertisements be withdrawn at least six months ago.

She agreed the program, jointly funded by the state and commonwealth governments, would offend some people, but said "unconventional" methods were sometimes required.

"Sometimes they have to go to extreme lengths to engage with these people," Ms Bligh said.

Technorati Tags: harm_reduction, australia, addiction, hiv_aids

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A reader comment

"I was recently in Vancouver and witnessed a man shooting up on the sidewalk. There were articles in the paper about how the misery on the streets in Victoria is scaring the tourists away and in my brief time in Vancouver there was plenty of misery to be seen as well. They certainly don't look like they have found the solution."

Study in rats suggests moderate alcohol consumption improves recall

Moderate alcohol consumption may actually improve memory:

Among the normal rats, the animals that consumed moderate amounts of alcohol fared better on both tests compared with the teetotalers. Rats on a heavy alcohol diet did not do well on object recognition (and, in fact, showed signs of neurotoxicity), but they performed better than their normal brethren on the emotional memory task.

Bad news if you recently experienced something that you don't want to remember too vividly, like trauma:

"People often drink to 'drown sorrows,'" Kalev says. "Our results suggest that this could actually paradoxically promote traumatic memories and lead to further drinking, contributing to the development of alcoholism."

Technorati Tags: alcohol, brain, memory, trauma

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More criticism of Canadian drug policy plan

First off, I am not at all in favor a the war on drugs and I'm skeptical of this new plan. (In my limited understanding, it emphasizes criminalization.) However, I believe that these comments from Stephen Harper make a lot of sense:

Harper unveiled a $63.8-million, two-year drug strategy in Winnipeg Thursday, saying harm reduction is not a "distinct pillar" of the Conservative strategy.

Vancouver's safe injection site is "a second-best strategy at best," he said, "because if you remain a drug addict, I don't care how much harm you reduce, you're going to have a short and miserable life."
...
Harper said Thursday: "I remain a skeptic that you can tell people we won't stop the drug trade, we won't get you off drugs, we won't even send messages to discourage drug use, but somehow we will keep you addicted and yet reduce the harm just the same."

These comments have been met with accusations of ignorance:

Mark Townsend, director of the Portland Hotel Society in Vancouver, said Harper doesn't understand the scourge of drug addiction.

"It's depressing to see his [Harper's] lack of leadership on that and now he is out there trying to find a new study that will say the world is flat," Townsend said.

A columnist for the Victoria Times-Colonist rails against the plan:

The problems of ideology-based governance clearly must be more obvious from afar. Otherwise, Canadians wouldn't be able to bear the hypocrisy of railing against oppressive and backward regimes elsewhere in the world while committing ourselves anew to the folly of a war on drugs.

...

The real tragedy is that the misuse of drugs continues to cost us $40 billion a year in Canada in direct and indirect costs, and that's not even counting all the billions we've thrown away on misguided and ideologically driven attempts to do something about that.

Here's the thing: Health issues can't be resolved through ideology.

...

So why do we continue to let our elected politicians ignore the science when it comes to drug issues? Why should anybody's poorly informed position around drug use be the lens that we apply when trying to address complex health and social problems that are far too important to be left to political whim?

I respect the right of Stephen Harper and his MPs to believe that using illicit drugs is bad. It's a free country and they're welcome to their opinions, and never mind that alcohol is actually Canada's most dangerous and readily available drug by a long shot. (The social costs of alcohol use in Canada are more than double that of all illicit drugs combined and health-related costs are three times higher.)

But why would we want to base something as important as our national drug strategy on opinion and belief?

We've got six decades worth of scientific studies underlining the importance of an informed, health-based approach in reducing the harm and societal costs of drug use. Yet we're still letting vital public policy be decided by people who would rather maintain their personal fictions than take steps to fix the problems.

This complete rejection of the role of values in policy decisions can't be serious. What about torture? Is the only acceptable argument against torture and argument that it doesn't work? I don't know anything about this writer, but I suspect she believes it is wrong and would oppose any pro-torture policy on moral grounds--even if torture was scientifically proven to be effective.

Granted, there's a long distance between torture and drug policy. The point is that we base policy decisions on values and morals all the time, even in health care. Are Canada's universal health care policies and the U.S. SCHIP programs based in pragmatism? They're based on moral
convictions about providing access to health care. Furthermore, the argument that harm reduction activism is value-free and rooted only in science is folly. HR arguments are consistently value-laden. For example, common themes include:

• Drug use is not bad
• Self-determination and personal liberty trump competing concerns
• Drug experimentation is a normal developmental task for adolescents

Would it be so difficult to build a dialog on drug policy around values? For example:

• Drug use is bad for addicts
• Recovery is the ideal outcome and should never be abandoned as a goal
• No one should be incarcerated for simple personal possession or use
• If an addict refuses recovery, we should still provide assistance with basic needs
  

How much common ground could be developed? What policy initiatives might arise?

One other truth that activists on both sides need to accept is that any policy that does not enjoy broad and deep public support will always be in peril. The general public will never embrace a policy focused on incarceration or a policy focused on needle exchanges, safe injection centers and drug maintenance programs.

Technorati Tags: harm_reduction, canada, addiction, policy