Addiction Inbox

The Dutch Smoke Less Pot

2009-11-19T06:09:00.005-06:00

One of those inconvenient truths.

Government drug policy experts don’t like the numbers, which is one of the reasons why you probably haven’t seen them. Among the nations of Europe, the Netherlands is famous, or infamous, for its lenient policy toward cannabis use—so it may come as a surprise to discover that Dutch adults smoke considerably less cannabis, on average, than citizens of almost any other European country.

A recent report by Reed Stevenson for Reuters highlights figures from the annual report by the European Monitoring Centre for Drugs and Drug Addiction, which shows the Dutch to be at the low end for marijuana usage, compared to their European counterparts. The report pegs adult marijuana usage in the Netherlands at 5.4 %. Also at the low end of the scale, along with the Netherlands, were Romania, Greece, and Bulgaria.

Leading the pack was Italy, at 14.6 %, followed closely by Spain, the Czech Republic, and France.

While cannabis use rose steady in Europe throughout the 1990s, the survey this year says that the data “point to a stabilising or even decreasing situation.” The study by the European Monitoring Centre did not include figures for countries outside Europe.

According to the Dutch government, Amsterdam is scheduled to close almost 20 per cent of its existing coffee shops—roughly 50 outlets--because of their proximity to schools. However, some local coffee shop proprietors maintain that far fewer shops, perhaps no more than 10 or 20, will actually be required to close.

What are the Dutch doing right? Are coffee shops the answer? It may be prove to be the case that cannabis coffee shops can’t be made to work everywhere—that the Dutch approach is, well, Dutch. However, the fact that it works reasonably well, if not perfectly, in the Netherlands is strong testimony on behalf of the idea of harm reduction.
Here are some excerpts from a flyer given out at some Dutch coffee shops by a group of owners known as the BCD, or Union of Cannabis Shop Owners:

--Do not smoke cannabis every day.
--There are different kinds of cannabis with different strengths, so be well informed.
--The action of alcohol and cannabis can amplify each other, so be careful when smoking and drinking at the same time.
--Do not use cannabis during pregnancy!
--Consult your doctor before using cannabis in combination with any medications you may be taking.
--Note that smoking is bad for your health anyway.
--Do not buy your drugs on the street, just look for a coffeeshop.

Customers must be over the age of 18, and in most coffee shops, as in bars and restaurants in the Netherlands and elsewhere, cigarette smoking is no longer allowed.

Photo Credit: www.us.holland.com

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Avoid Cigarettes and Alcohol to Avoid Depression [Guest Post]

2009-11-12T04:59:00.005-06:00

[From time to time, Addiction Inbox posts contributions from other bloggers. Views expressed belong to the guest poster and do not necessarily represent my own]

Christine Howell is a writer who regularly writes about online health care degrees and college related topics for Online College Guru, an online college directory and comparison website.

While there are definite correlations between depression and the use of alcohol and cigarettes, scientific opinions vary on the nature of those correlations and to what extent alcohol and nicotine create depressive symptomology. Alcohol has long been known to have demonstrated negative effects on mood and health; tobacco use has been linked to lung cancer and emphysema, among other medical conditions. Recent studies, however, indicate a more direct role in depression for both nicotine and alcohol use.

In 2007, the Columbia University National Center on Addiction and Substance Abuse released its findings on the link between depression and smoking in teenagers. The study showed clear evidence that teens who smoke are more than twice as likely to experience the symptoms of depression in the course of a given year than non-smoking teenagers. This reinforces the results of a previous study published in the journal Pediatrics in October 2000, which showed a direct causal link between cigarette smoking and depression in adolescents. Previous studies had noted the link, but were unable to demonstrate causality; the 2000 study showed that teens who showed no signs of depression were four times more likely to become depressed during the course of a year’s time if they began to smoke, as opposed to those who did not smoke cigarettes at all.

The effects of alcohol are significantly worse since it is itself a depressant. Alcohol works on the central nervous system by lowering the levels of serotonin and norepinephrine; by way of contrast, antidepressants typically work by increasing those same levels. For patients already suffering from depression, alcohol produces the precise symptoms they are already experiencing; alcohol use can worsen the severity of depression and increase its duration by rendering the pharmaceutical treatments ineffective. The negative effects of alcohol use on depression increase as frequency and amount consumed increase; this positive correlation is linked to the cumulative effect of alcohol’s reduction in serotonin and norepinephrine levels.
A study conducted by Johns Hopkins University and published in the American Journal of Epidemiology in 1997 showed a gender-based correlation between depression and alcohol usage. According to the study, for men, alcohol was a causal factor in their subsequent depression; women tended to use alcohol as a result of their depression, possibly in an attempt to self-medicate depressive symptoms.

For those recovering from alcohol abuse, depression can be an unwelcome result of alcohol withdrawal. A University of North Carolina School of Medicine study found that when mice were habituated to alcohol, withdrawal caused depressive symptoms. The study also demonstrated a link between alcohol use and a failure to produce new neurons in certain areas of the brain necessary for proper cognitive function. Many patients struggling with the recovery process turn to coffee and cigarettes to assist them in combating alcohol abuse; ironically, cigarettes have been shown to be a factor in greater risks of relapse, and are not recommended for recovering alcoholics for this reason. Coffee does not have a similar correlating effect.

Certain conclusions can be derived from the existing evidence. Especially for adolescents and those with a predisposition to depression, alcohol and cigarettes should be avoided as they worsen the effects of depression and can trigger it even in those not already demonstrating depressive symptoms. Those in recovery from alcohol abuse should be considered at high risk for depression, and should avoid cigarette use in order to avoid relapse during this critical time. Additionally, men should be especially careful in their use of alcohol, as it has been shown that men are more likely than women to suffer from depression as a direct result of their alcohol usage. For most people, avoiding the use of these mood-altering substances altogether is the best precaution against developing alcohol and nicotine related depression.

Photo Credit: www.onlyhealthtopics.info

Needle Exchange in America

2009-11-06T12:44:00.006-06:00

AIDS/harm reduction activists press Obama.

First, the good news: After 20 years, the U.S. Congress has voted to remove the funding ban on syringe exchange programs designed to combat AIDS and to bring hard drug users within the orbit of the medical health community.

Now, the bad news: Conservative legislators have managed to insert a provision in the bill prohibiting needle exchange centers within 1,000 feet of schools, day care centers, colleges, playgrounds, youth centers, swimming pools—and just about any other institution you care to come up with. In short, the legislation would make it virtually impossible to operate a viable needle exchange program, even if sufficient levels of federal funding can be obtained. As one harm reduction activist put it in the Seattle Stranger: The only place you could put a federally-funded needle exchange program in the entire city of Chicago... is O’Hare Airport? Gee, it’s almost like Democrats aren’t really serious about allowing funding live-saving needle programs at all.”

Clearly, needle exchange activists are still waiting for an unambiguous sign from the White House that Obama plans to uphold his campaign promises in this regard. Obama’s go-slow policy on needle exchange has frustrated AIDS activists in particular.

Physicians for Human Rights, a group that supports clean syringe exchange programs, made October 14 a National Call-in Day, noting on its web site that “Senators need to hear from President Obama that his Administration supports syringe exchange. Now is the time to urge President Obama to fulfill his campaign promise to end the ban and to urge the Senate to act.”

In a post in January of this year, I wrote: “Obama’s agenda, as spelled out at Whitehouse.gov, calls for rescinding the ban in an effort to save lives by reducing the transmission of HIV/AIDS. ‘The President,’ according to the agenda, ‘supports lifting the federal ban on needle exchange, which could dramatically reduce rates of infection among drug users.’"

Syringe exchange programs, Physicians for Human Rights declares, “do more than provide clean syringes and properly dispose of used ones; they link people into the health care system and drug treatment programs that save lives.”

In short, says the group, “the presence of syringe exchange programs in communities does not increase rates of drug use, nor does it lead to a rise in crime. What it does do: decrease transmission of HIV, Hepatitis C and other diseases.”

Moreover, during his confirmation hearings drug czar Gil Kirlikowske said that “a number of studies conducted in the US have shown needle exchange programs do not increase drug use.”

It’s a confusing picture in the field: Needle exchange programs exist, in San Francisco, Toronto, New York and other major metropolitan areas, because county and other local and regional officials have authorized it, even when funding was precarious. Alongside these programs, a plethora of illegal needle exchange operations is also in place. The Drug War Chronicle quoted the Western director of the Harm Reduction Coalition: “We need to get legislation authorizing syringe exchanges on a statewide level.... Requiring local authorization means we have to deals with 54 jurisdictions instead of just one.”

Back in May, Maia Szalavitz reported in Time that the president was planning to move deliberately as part of a broader HIV/AIDS strategy, even though groups from the World Health Organization (WHO) to the American Medical Association have gone on record with the view that giving clean needles to drug addicts is a successful strategy to reduce the spread of HIV disease. Studies by Don Des Jarlais of Beth Israel Hospital in New York suggest that infection rates in New York’s drug addict population may have dropped more than 75 % over the last few years as clean needle programs became increasingly available.

In a report last month by the Drug Reform Coordination Effort (DRCNet), a spokesperson for the AIDS Action group was determined to remain positive. “I have a pretty good feeling about this,” he said. “I’m hopeful this is the year.”

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The Black Market for Seroquel

2009-11-02T14:27:00.007-06:00

Speed freaks, coke heads, and antipsychotics.

Last week, writing on the Daily Beast web site, reporter Jeff Deeney profiled a startling underground market for the antipsychotic medication Seroquel (quetiapine). Deeney described street transactions in North Philadelphia for Quells or Suzie-Qs, as the drug is sometimes called. Seroquel, a drug developed for the treatment of schizophrenia and bipolar disorder, has developed an additional reputation as a “comedown” drug for stimulant abusers.

Seroquel, a so-called atypical antipsychotic, works by altering levels of dopamine. While some addicts have claimed that the drug is perfect for a cocaine or speed comedown, Seroquel has also been studied for its anti-craving properties when used for cocaine abstinence.

Why would a speed freak or a coke addict want to take a drug that might decrease their desire for their stimulant of choice? For the same reason that ecstasy users often take a morning-after dose of Prozac in a misguided attempt to compensate for possible damage to serotonin receptor arrays. Or because the drug is mildly sedating for some users. However, there may be more to it. Perhaps Seroquel is an effective anti-craving medication for cocaine and methamphetamine addicts, who misuse it as a drug to ease them through enforced periods of detox or lack of availability.

One high-traffic drug discussion site has shut down a long-standing thread on Seroquel with the warning: “Do not use Seroquel for a cocaine comedown.”

The fact that prescription Seroquel is available as a street drug, at least in some parts of the country, demonstrates the likelihood that physicians and psychiatrists are increasingly using it for off-prescription purposes—like drug detox. Deeney strongly suggests that this is the case: “Drug dealers, mandated to treatment as a condition of their probation or parole, are given off-label prescriptions for Seroquel, then sent right back to the street, where the pills can be sold for cash to users and other dealers.”

Increasing its appeal is Seroquel’s reputation for combining well with cocaine in a mixture known as a Q-Ball, or Rosemary’s Dolly—a variation on the heroin/cocaine mix known as a Speedball, to which Seroquel can also be added. An anonymous med student on a medical blog noted that “certain people say they love Seroquel when doing a speed-ball. Makes sense, think about it. It heightens the high of the heroin, it eases the crash of the cocaine.”

Seroquel’s ability to modulate the effect of illegal drugs means that the medication can possibly find a market both as a detox drug for stimulant abusers, and as an ingredient in the very stimulants they abuse.

By itself, Seroquel is not considered addictive. Some addicts told Deeney that the drug simply put them to sleep more quickly after a long meth run. Indeed, Seroquel is considered to be more sedating than similar antipsychotics such as Olanzapine and Aripiprazole. The larger issue, as the Daily Beast post makes clear, is that “Seroquel can have serious side effects including diabetes, a permanent Parkinson’s-like palsy called tardive dyskinesia, and sudden cardiac death.”

All of this confusing and sometimes contradictory input is coming well ahead of the clinical data, although a study in 2001, presented at the 4th International Conference on Bipolar disorder, found that quetiapine caused a significant reduction in cocaine use among a small group of cocaine-dependent subjects who also suffered from bipolar disorder. A report last year in the Journal of Clinical Psychopharmacology also showed positive results with cocaine users. Studies of quetiapine for the reduction of cocaine use are currently being undertaken by the Seattle Institute for Biomedical and Clinical Research.

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To Flush or Not To Flush

2009-10-30T09:36:00.003-05:00

t
FDA lists meds for trash or toilet.

A recent post here on the subject of illegal bong water in Minnesota—coupled with a perceptive comment by a reader about drugs in the water supply—got me thinking again about what gets thrown in the sink or flushed down the toilet.

I was surprised to discover that, according to the Food and Drug Administration (FDA), consumers are better served by flushing some drugs down the toilet. The FDA has put up a web site dedicated to the proposition that flushing drugs is the preferred method for certain kinds of drugs—but not for every kind of drug.

While noting that “flushing is not recommended for the vast majority of medicines,” the FDA asserts at druginfo@fda.hhs.gov that “certain medicines may be especially harmful and, in some cases, fatal in a single dose...” To dangerous, in other words, to leave around the house or in the trash.

The potential for fatal overdose, particularly with prescription morphine and its derivatives, suggests that flushing will be the preferred method of disposal unless or until communities and pharmaceutical companies get serious about take-back programs and other medicine disposal services.

Specifically, drugs recommended for flushing include:

--Morphine Sulfate (Morphine, Avinza, Embeda, Kadian, MS Contin, and Oramorph).

--Fentanyl Citrate (Actiq, Duragesic, Fentora, Onsolis).

--Meperidine Hydrochloride (Demerol).

--Methylphenidate (Daytrana).

--Hydromorphone Hydrochloride (Dilaudid).

--Methadone Hydrochloride (Methadone, Methadose, Dolophine).

--Oxymorphone Hydrochloride (Opana).

--Oxycodone Hydrochloride (Oxycontin, Percocet, Percodan).

-- Sodium Oxybate (Xyrem).

The FDA says that the disposal of “these select, few medicines by flushing contributes only a small fraction of the total amount of medicine found in the water. FDA believes that any potential risk to people and the environment from flushing this small, select list of medicines is outweighed by the real possibility of life-threatening risks from accidental ingestion of these medicines.”

The preferred disposal method for all other drugs, says the FDA, is to mix them with kitty litter or coffee grounds, place the mixture in a sealed plastic bag, and throw the container in your household trash.

Photo Credit: www.pri.org

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Alcohol and In Vitro Fertilization

2009-10-25T13:09:00.009-05:00

Do drinking women face tougher odds?

Everybody knows by now that it’s not safe to drink while pregnant. However, a new study of more than 2,500 couples enrolled in a course of in vitro fertilization (IVF) treatment at a fertility clinic found that women who drank more than a single drink per day significantly reduced their likelihood of pregnancy, according to a report by doctors at the Harvard Medical School in Boston.

Now, it may not even be a good idea for women to drink while trying to get pregnant. And that includes you men out there as well.

Dr. Brooke Rossi presented the findings last week to a meeting of the American Society of Reproductive Medicine. In the study cohort, half the women and a third of the men had less than one drink per week, while about 5% of men and women had at least one drink per day. According to Dr. Rossi, women were 18% less likely to have a successful IVF baby if they drank at the higher level. Men who had more than six drinks per week reduced the rate of successful in-vitro fertilization by 14 %.

The average age of women taking part in the study was 34, and for men, the average age was 37. Tony Rutherford, chairman of the British Fertility Society, told the UK Guardian that “this is further evidence to suggest that alcohol does have an impact.” Rutherford agreed with the study authors at Harvard that women who wish to become pregnant should stop drinking.

In 1998, the British Medical Journal published a Danish study of more than 400 couples that concluded: “A woman's alcohol intake is associated with decreased fecundability even among women with a weekly alcohol intake corresponding to five or fewer drinks.” The authors conceded, however, that other studies have found little evidence of an alcohol effect on conception rates.

“It may well be that couples who are already subfertile are more affected by alcohol than those who are perfectly fertile,” Rutherford speculated. “Eggs and sperm take at least three months to develop so women have got to stop smoking, reduce alcohol consumption, or, if you are overweight, correct that weight, that far ahead if you want to maximize your chances of conception.”

Photo Credit: www.babble.com

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Bong Water Illegal in Minnesota

2009-10-23T13:40:00.005-05:00

State Supreme Court calls it a “drug mixture.”

The lesson is clear: If you live in Minnesota, and you happen to own a bong, be sure to pour out the water after each use.

Bong water is now officially a controlled substance in Minnesota, according to a state Supreme Court ruling last week. An Associated Press report by Steve Karnowski in the Minneapolis Star Tribune said the decision “raises the threat of longer sentences for drug smokers who fail to dump the water out of their pipes.”

The decision (PDF HERE) reverses two lower court rulings, which dropped charges in a case where a search of a Minnesota home included the discovery of a glass bong with 37 grams of liquid that tested positive for methamphetamine. Rice County authorities charged the homeowner with a first-degree drug offense for possession of a “drug mixture.”

The Minnesota Supreme Court ordered the case back to Rice County District Court prosecutors. The 4-3 decision, authored by Justice G. Barry Anderson, said that the bong water was clearly a drug “mixture” and therefore subject to state drug statutes. Anderson also wrote that a narcotics officer had alleged that drug users sometimes drink or inject bong water.

Justice Paul Anderson, writing in dissent, claimed the majority decision “borders on the absurd.” Bong water as a drug mixture carries a penalty of up to seven years in prison. However, when defined as drug paraphernalia, which is conventionally the case, the offense is a misdemeanor carrying a $300 fine and no jail time.

An attorney for the woman arrested and charged in the case said that officials were treating his client, “who had two tablespoons of bong water, as if she were a major drug wholesaler.”

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How Pure Is Ecstasy?

2009-10-21T17:12:00.004-05:00

Dutch study of street MDMA.

For 16 years, the Drugs Information Monitoring System (DIMS) in The Netherlands has gathered and analyzed tablets of purported MDMA sold on the street as Ecstasy. In a research report published in Addiction, Neeltje Vogels and others at the Netherlands Institute for Mental Health and Addiction in Utrecht found that between 70 to 90 % of the samples submitted as MDMA were pure. The most common non-MDMA adulterant was found to be caffeine.

The study covered the years from 1993 to 2008. In the mid to late 1990s, researchers saw an increase in ephedra and methamphetamine in the samples, and sample purity hit an all-time low of 60% in 1997. The years from 2000 to 2004 were the golden era, so to speak, for MDMA purity. “After 2004,” the study authors write, “the purity of ecstasy tables decreased again, caused mainly by a growing proportion of tablets containing meta-chlorophenylpiperazine (mCPP).” mCPP belongs to a class of stimulants, the so-called piperazines, that have been banned in several countries (See my post).

As noted on the DrugMonkey science blog, a lack of consistent published data has hampered efforts at studying street MDMA. Tablets for analysis are obtained either from law enforcement—which seizes drugs that may or may not be for sale at the club level--or drug analysis and harm reduction sites. The problem, DrugMonkey writes, is that “perhaps Ecstasy found to result in suspicious subjective effects on the user are submitted to harm reduction sites preferentially.” In other words, people only submit the brown acid.

The Dutch study, on the other hand, obtained samples for testing from capsules seized by club owners and given to the police, who then passed them on to DIMS for analysis. This system helped eliminate the possible bias effect of voluntary submissions.

The study also found that larger tablets, containing 100 mgs or more of MDMA, became increasingly popular starting in 2001.

DrugMonkey, an anonymous NIH-funded biomedical researcher, calls the study “an impressive longitudinal dataset.” The data, he wrote, give us “a good picture of the percentages of MDMA-only across time (higher than certain MDMA fans seem to acknowledge when it comes time to assess medical emergency cases) and the relative proportions of specific contaminants (certain baddies are quite rare.)”

Specifically missing in action most years is the baddy known as PMA, or para-methoxy-amphetamine, which has been implicated in many of the alleged Ecstasy deaths by overheating--a condition known as hyperthermia.

Graphics Credit: National Institute on Drug Abuse

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Moderate Drinking: The Debate Continues

2009-10-18T13:48:00.005-05:00

New study says it’s the lifestyle, not the alcohol.

Ever since the first studies showed modest statistical health benefits for people who drank a light to moderate amount of alcohol, the debate has bounced back and forth among researchers. Now an Italian study of more than 3,000 older adults, published in the Journal of the American Geriatrics Society, claims that it is the moderate lifestyle of drinkers, and not the alcohol itself, which helps prevent functional decline as we age.

After controlling for body weight, level of physical activity, education, and income, Cinzia Maraldi and coworkers in the Department of Clinical and Experimental Internal Medicine at the University of Ferrara pointed the finger at lifestyle characteristics—primarily weight control and exercise.

The researchers did not dispute the finding that moderate levels of alcohol intake can lower the risk of cardiovascular disease--but lead author Maraldi said in a press release that “the benefit of alcohol intake on other health-related outcomes is less convincing.”

Maraldi said the positive effects of moderate alcohol on physical aging and cognitive impairment in the elderly may be only apparent, “because life-style related characteristics seem to be the real determinant of the reported association.”

The research follows earlier U.S. studies suggesting much the same thing. A finding that had become common folk wisdom—with perhaps a little nudge from the alcoholic beverage industry--is now openly disputed by scientists.

“The moderate drinkers tend to do everything right,” said sociologist Kaye Middleton Fillmore, in a New York Times article by Roni Caryn Rabin. “They exercise, they don’t smoke, they eat right and they drink moderately.” In the same article, an Oakland cardiologist said: “It’s very difficult to form a single-bullet message because one size doesn’t fit all here, and the public health message has to be very conservative.”

In the New York Times article, Dr. Tim Naimi of the Centers for Disease Control and Prevention said: “The bottom line is there has not been a single study done on moderate alcohol consumption and mortality outcomes that is a ‘gold standard’ kind of study—the kind of randomized controlled clinical trial that we would be required to have in order to approve a new pharmaceutical agent in this country.”

Photo Credit: Rhodes University

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Another Round of Trials for Vigabatrin

2009-10-15T16:45:00.003-05:00

Firm secures funding for anti-craving tests.

A Florida pharmaceutical company has secured financing for additional testing of the anti-addiction drug vigabatrin, despite the drug’s poor performance in earlier trials. Patrick J. McEnany, chairman and CEO of Catalyst Pharmaceuticals (CPRX) in Coral Gables, said the company would continue developing CPP-109 , its version of vigabatrin, for the treatment of cocaine and methamphetamine addiction.

Vigabatrin garnered early publicity on the basis of early trials suggesting it might be effective against stimulant addiction. Unlike alcohol and heroin, cocaine and speed have proven particularly resistant to treatment with other drugs designed to diminish craving. A drug that effectively reduced craving in abstinent cocaine and methamphetamine addicts would open up a potentially large and lucrative market.

Catalyst said it raised $3.97 million in a recent common stock offering from a group of investors including Federated Kaufmann Funds. Catalyst owns exclusive licensing rights to several patents related to vigabatrin from Brookhaven National Laboratory, reports Genetic Engineering and Biotechnology News. The company also owns patents or patent applications in more than 30 countries. Catalyst recently acquired worldwide rights to a related patent held by Northwestern University.

Earlier, the U.S. Food and Drug Administration (FDA) had given Fast Track designation to vigabatrin. The drug increases brain levels of GABA, an inhibitory transmitter. However, CPP-109 failed in a mid-stage treatment for cocaine addiction. Brian Bandell of the South Florida Business Journal reported that during the 12-week study, the drug did not help addicts stay cocaine-free, compared to a placebo group. In July, the company’s stock was trading at a 52-week low of 39 cents.

Last week, Catalyst said its decision to renew testing and development efforts with vigabatrin was due to a reanalysis of data from the earlier test. The company said the review showed that overall test subject compliance rates during the clinical trial may have been as low as 40 %. The company also said that early results with methamphetamine addiction were promising, but not statistically significant due to the small number of test subjects.

Last year, there was also a flurry of interest in vigabatrin as a weight loss drug. (See my earlier post). The FDA has yet to approve the drug for use in the U.S., citing concerns about reports of retinal damage in patients overseas. Catalyst said it had not uncovered any clinically significant visual abnormalities in its CPP-109 testing programs.

Vigabatrin, or gamma vinyl-GABA, is marketed in Europe as Sabril, and has existing clinical uses for the treatment of specific types of epilepsy and infant spasms.

Graphics Credit: www.dosewatch.com

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Top 50 Smoking Awareness Blogs

2009-10-14T10:45:00.007-05:00

Addiction Inbox makes the cut.

Addiction Inbox is pleased to find itself listed among the "Top 50 Smoking Health Awareness Blogs" by the Pharmacy Technician Certification web site.

Here is the description included in the listing:

"An exhaustive, comprehensive, and stimulating catalogue of information pertaining to the science of substance abuse, the Addiction Inbox counts nicotine amongst its list of dangers. Expect to see articles regarding tobacco control alongside psychological studies on the physical, emotional, and mental elements of addiction."

Thanks go to Ashley M. Jones for the listing, and for bringing it to my attention.

The latest numbers on cigarette smoking from the American Heart Association show that 23.5 % of white males are smokers, with female smokers having closed the gap considerably with a smoking rate of 18.8 %.

26.1 % of black men are smokers, compared to 20.1 % of Hispanic males, and 16.8 % of Asian men. For women, blacks smoke at a rate of 18.5 %, followed by Hispanic women at 10.1 %, and non-Hispanic Asians at 4.6 %.

The tragic winners, and thus the losers, of the smoking sweepstakes are Native Americans, who show smoking rates of 35.6 % for men and 29.0 % for women.

Graphics Credit: www.chantixhome.com

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The Rehab Scandal: Relapse Rates

2009-10-11T11:12:00.004-05:00

If 8 out of 10 addicts fail, is it really treatment?

The British drug treatment and recovery community has been squabbling recently over annual figures published by the National Treatment Agency (NTA) showing a marked increase in the number of people in drug treatment programs in Britain.

BBC home editor Mark Easton dug into the data and found that, of 202,000 people in treatment, a total of 7,324 “left the treatment programme drug free last year.” Ergo, “Just 3.6 % of those in treatment were discharged free of illegal drugs. “

Andrew Brown, a writer who covers addiction and substance abuse, cited studies showing relapse rates of 80 % or more, and wrote in the UK Telegraph that residential treatment advocates “can be fervent, and persuasive, in their enthusiasm, especially those individuals for whom rehab represents the turning point in their battle with addiction. But the fact is that the expected outcome from most people who enter a treatment centre remains—relapse.”

In the current issue of Newsweek, science writer Sharon Begley gives us some inadvertent clues. Since most residential treatment therapy revolves around individual and group counseling by psychologists, not M.D.s or prescribing psychiatrists, it is unnerving to discover, in a study highlighted by Begley, that clinical psychologists in general practice do not necessarily use “the interventions for which there is the strongest evidence of efficacy.” In other words, where’s the science?

This is an argument that severely rankles psychologists, naturally enough. But Begley writes that because of rigorous clinical trials, we know, for example, that cognitive behavioral therapy can be effective against depression, OCD, bulimia, and other strongly serotonin-mediated disorders. “Neuroscience,” writes Begley, “has identified the brain mechanisms by which these interventions work, giving them added credibility.”

What, then, do we find being used as therapeutic tools in such situations by psychotherapists in the trenches, including those in addiction treatment facilities? The answer, according to Begley, is likely to be “chaotic meditation therapy, facilitated communication, dolphin-assisted therapy, eye-movement desensitization....”

Begley could have added sacral cranial therapy, electric acupuncture, and a host of other questionable practices now subsumed under the broad rubric of clinical psychology. The point is obvious: With more than a thousand brands of psychotherapy currently being practiced, it is safe to say that the field is rife with conflicting opinions about what works.

The problem is that the addicted person has no way of knowing whether the clinical therapy on offer during treatment is backed up by enough sound scientific evidence to warrant participation.

As long as clinics are showing relapse rates not unlike those shown by alcoholics and other addicts going it alone, patients and those involved in their recovery have every reason to view addiction therapy programs with a critical eye.

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World Mental Health Day

2009-10-08T10:56:00.006-05:00

Primary health care vs. mental health care.

Mental health care, including addiction, has traditionally run on a separate but very unequal track, compared to primary health care. Of the more than 450 million people around the world who suffer from a mental disorder, it is estimated that fewer than half receive medical help of any kind. Most developed countries have carved out mental health services as a distinct medical institution—one marked by less funding, reduced options, limited services, and little connection to overall health care needs.

Saturday, September 10, marks the 17th annual World Mental Health Day. Established by the World Federation for Mental Health, the day is commemorated through a variety of events and programs in more than 100 countries. The group calls for sustained advocacy on behalf of quality care for people with mental and emotional health problems all over the world.

The campaign theme for 2009 is “Mental Health in Primary Care,” with a focus on worldwide efforts to shift mental health diagnosis into mainstream healthcare. Primary care is the term used to describe the long-term relationship between an individual and their doctor. A person’s general doctor provides for health needs and coordinates additional doctors and services when needed.

The World Federation for Mental Health notes that “neurological disorders starting in the brain were once seen as a separate matter, not needing any physical monitoring—but in recent years there as been greater recognition of the very important link between good mental health and good overall health.”

The report also states that “those with severe and persistent mental illnesses are often twice as likely to have multiple physical health issues.”

Why is this shift a good idea? According to a study released last year by the World Health Organization (WHO) and the World Organization of Family Doctors, this approach has several advantages: “People can access mental health services closer to their homes, thus keeping families together and maintaining their daily activities.... Mental health care delivered in primary care minimize stigma and discrimination, and remove the risk of human rights violations that occur in psychiatric hospitals.”

In addition, according to the study:

--Most people seek help for mental health problems in primary care settings.

--Mental health problems frequently go untreated in the primary care environment.

--People of color, children, and the elderly are the least likely to receive appropriate care for psychiatric disorders.

--Primary care diagnosis of mental health problems reaches people who cannot or will not undergo specialty mental health care.

Graphics Credit: www.unmultimedia.org

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Banning legal drugs

2009-10-05T20:57:00.005-05:00

Fool’s errand or necessary evil?

In the cat-and-mouse game that is the designer drug industry, spinning new variations on old themes is the name of the game. When law enforcement and the courts decree a substance illegal for human use due to abuse potential—like the “date rape” drug GHB, banned several years ago in the U.S. and Britain—underground drug designers go to work on spinning molecular variations on the theme. When they hit on an acceptable “near-beer” equivalent, they can flood the market and reap another tidy illegal round of profits on, for example, GBL, which the body converts to GHB when consumed. That is, until law enforcement catches up with that one, and bans it, and then the cycle repeats itself.

The Analogue Drug Act of 1986 was designed to combat this dilemma in the United States by outlawing drugs “substantially similar” to any drug that is already illegal. However, “chemical experts disagree on whether a chemical is “substantially similar” in structure to another chemical—so much so that Federal Analogue Act litigation often degenerates into a “battle of experts,” which is founded more on opinion than on actual scientific evidence,” writes Gregory Kau in an article for the University of Pennsylvania Law Review. “One survey of Federal Analog Act jurisprudence discovered that courts sometimes considered a chemical’s two-dimensional structure rather than the three-dimensional structure as a factor; that courts sometimes ignored the difference in the number of atoms as a meaningful factor; and that courts even ignored quantitative “similarity analysis” results that pharmaceutical companies use to determine whether a chemical is structurally similar to another.”

Recently, Britain added itself to the list of nations that have banned several so-called “herbal highs,” mostly industrial chemicals or synthetic cannabinoids. In addition to GBL, or gamma-butyrolactone, the ban includes BZP, or benzylpiperazine, sold as a stimulant club drug similar to amphetamine. Both are already illegal in the U.S.

In addition, the British Home Office banned a substance known variously as Spice, Spice Gold, or Spice Diamond, which is sold as a legal herbal alternative to cannabis. The product was banned in Germany and France earlier this year. Over the past two years, tests at a German pharmaceutical company, and assays of Spice products seized by U.S. customs agents have confirmed the presence of several synthetic versions of natural chemicals found in marijuana. These cannabinoids include JWH-018, CP-47,497, and HU-210 in liquid form, which is then sprayed on herbal products. The chemicals in question currently find use only in medical research, and the extent to which they provide a high in the absence of THC is based on anecdotal reports, and varies widely.

GBL, a chemical solvent used as a paint stripper, is sometimes sold as “liquid ecstasy.” The amphetamine alternative BZP is used as a fertilizer and as a veterinary medicine. Both are now classified as Class C drugs like tranquilizers, possession of which can bring a two-year jail sentence.

Spice, or at least the synthetic cannabinoids the products contain, are now listed as Class B drugs, the same as marijuana, bringing with it the possibility of a five-year jail sentence.

In an attempt to gain a leap on underground drug designers, the British government has banned all drugs in the so-called piperazine family that includes BZP. This will likely motivate underground chemists to find a molecular family with similar effects to BZP.

Graphics Credit: www.images.tilllate.com

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Russian Heroin Addiction “Spreads Like Wildfire”

2009-09-27T15:44:00.004-05:00

Is defoliating Afghanistan the answer?

Last week, both the New York Times and the Los Angeles Times declared that heroin addiction has reached epidemic proportions in Russia. However, Soviet drug enforcement officials have a plan: They have called on the United States to defoliate Afghanistan.

For years now, Russia has been flooded with cheap opium from Afghanistan, smuggled in through Tajikistan and other countries along Russia’s “virtual borders” in Central Asia. What began as a trickle of addicted Russian soldiers during the Afghan war in the 1980s has reached epidemic proportions, Russian officials maintain.

“It’s a catastrophe for us,” a Moscow drug addiction specialist told the Los Angeles Times in an article by Megan K. Stack. “We were completely unprepared for this turn of events.” The Times article notes that the flood of cheap heroin has largely been met with “widespread public ignorance of the risks and symptoms of addiction, lingering shame and stigma, and muddled government efforts at treatment.”

To cap things off, methadone is illegal in Russia.

The New York Times reported in an article by Ellen Barr y that Afghan poppy cultivation had become a diplomatic sore point between Moscow and Washington. “I would call on the United States to use defoliation from the air,” said Viktor P. Ivanov, Russia’s Drug Czar, so to speak. “There are people who support this method in the United States. The debate is going on, which is important.”

Russian authorities estimate that 30,000 young Russians dies each year from drug use, predominately Afghan heroin. Although the nation’s opium crop has shrunk in recent years, “Afghanistan still produces more opium than the worldwide market can absorb,” according to Ellen Barry. The reserve may have grown to 10,000 tons, representing a two-year world supply, according to a recent United Nations report.

Years earlier, officials in the Bush administration had briefly investigated an aerial spraying program in Afghanistan, but backed off amid fears that the move would stoke anti-American anger by depriving farmers of their livelihood and increasing the likelihood that they would join the insurgents. The U.S. undertook a largely ineffective manual eradication campaign, and the Obama administration has thus far focused efforts on interdiction and the cultivation of alternative crops, according to the New York Times report.

Photo Credit: www.stratfor.com

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FDA Bans Flavored Cigarettes

2009-09-23T23:05:00.004-05:00

An unintentional boost for cigar sales?

When is a cigar more than just a cigar? When its appearance allows it to circumvent the intent of the Food and Drug Administration’s first ruling related to cigarettes, that’s when.

In its first official ruling since Congress passed legislation giving the agency authority to regulate tobacco (see my earlier post), the FDA banned so-called flavored cigarettes. Cigarette makers can no longer add vanilla, clove, chocolate, or any other fruit or candy flavors to their product. Menthol, for now, is exempt from the ban.

FDA commissioner Margaret Hamburg said that 90 percent of adults who smoke began doing so as children. The president of the Campaign for Tobacco-free Kids agreed, calling flavored cigarettes “starter products” for young smokers in a Dow Jones Newswires report by Jennifer Corbett Dooren.

By law, the agency cannot ban regular cigarettes outright. However, as Gardiner Harris reported in the September 23 New York Times, “the legislation left some details vague. For instance, the agency is required to ban flavored cigarettes, but the law did not clearly define what constituted a cigarette."

Huh? As it turns out, a cigarette is in the mind of the beholder. The FDA maintains that the ban applies to all cigarette-type tobacco products, including those that are “labeled as cigars or as some other product.” A spokesperson for the Campaign for Tobacco-Free Kids agreed: “The FDA demonstrated that they’re serious about enforcing the ban on flavored cigarettes, and serious about preventing tobacco companies from circumventing that ban,” according to the New York Times article.

Not so fast, argued Norman Sharp, president of the Cigar Association of America. Sharp told the Times that the ban clearly did not apply to cigars: “We feel this should go a long way to clearing up any confusion in the marketplace.”

Well, not exactly. An exasperated spokesperson for cigarette maker R.J. Reynolds, also quoted in the article, said: “It’s hard to understand. We need clear and timely guidance so all of us can work together so that we can understand what we need to be doing.”

What about the small brown cigarillos sold by an R.J. Reynolds subsidiary?

“They are not cigarettes,” the spokesperson said.

Photo Credit: http://politics.mync.com/tag/cigarette/

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Kudzu for Alcoholism?

2009-09-20T12:43:00.005-05:00

Common vine extract may inhibit drinking.

Score one for traditional Chinese folk medicine. A compound called daidzin, found in kudzu vine, acts like the anti-drinking medication Antabuse. Daidzin interferes with the metabolization of alcohol and causes the well-known flushing and sick feeling associated with Antabuse.

However, Dr. Ivan Diamond of the University of California in San Francisco and Dr. Ting-Kai Li of Duke University Medical Center maintain that a synthetic derivative of the active ingredient in kudzu vine also helps diminish the desire to drink in alcoholic rats. It does so, they believe, by preventing alcohol-induced increases in dopamine in the brain’s pleasure center. This additional finding about daidzin may help prevent relapse in recovering alcoholics by diminishing cravings—something Antabuse does not do.

The study will be published in the November issue of Alcoholism: Clinical and Experimental Research.

Currently, the commonly prescribed medications for alcoholism include disulfiram (Antabuse), naltrexone (Revia and Vivitrol), acamprosate (Campral), topiramate (Topamax), and baclofen (Lioresal).

Harvard researchers Wing Ming Keung and Bert Vallee first discovered the effects of kudzu on drinking. A 2005 paper in Alcoholism: Clinical and Experimental Research, authored by Scott E. Lukas, et. al., reported the results of testing a kudzu extract on a clinical population of “heavy” drinkers. The result: “Kudzu treatment resulted in significant reduction in the number of beers consumed... and a decrease in the volume of each sip.” The earlier researchers, however, did not report any significant effect on the urge to drink.

In their recent research, Diamond and Li believe they have found a synthetic version of daidzin, CVT-1-216, that does effect the desire to drink. According to Diamond, the study found that the drug “prevents the usual increase in drinking (binge drinking) that occurs after five days of abstinence....”

“Extracts of various parts of the kudzu vine have been used in many Chinese herbal medicine formulas and are said to be helpful in treating a variety of maladies,” said Dr. Li, who was formerly the director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). “The findings show promise that CVT-10216 might be better tolerated than Antabuse,” he added.

Dr. Diamond called alcoholism “a medical disorder, not just a problem of will power. Physicians treat medical disorders in order to prevent harm, while not necessarily curing the disease being treated—for example, drug treatment of hypertension, stains for high cholesterol, insulin for diabetes—and the same will become true for treating alcoholism.”

Diamond also agrees that synthetic kudzu extract may prove superior to Antabuse in other ways. “Most believe that disulfiram (Antabuse) would not be approved today as a new drug for alcoholism because of its many toxicities.”

Photo Credit: www.skrewtips.com

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Low-Nicotine Cigarettes: Deadlier Than Regular Brands?

2009-09-14T12:28:00.004-05:00

More tars, more cancer.

Now that the U.S. Congress has passed legislation enabling the Food and Drug Administration (FDA) to monitor the tobacco industry for the first time in history (see my earlier post), one of the primary issues the agency must deal with are health claims on behalf of allegedly less-toxic brands of “low-nicotine” cigarettes.

It has long been understood, and demonstrated clinically, that people addicted to nicotine will smoke “light” cigarettes harder, and in greater numbers, in order to compensate and obtain the same amount of nicotine they are used to--thereby staving off withdrawal. [See graphic at right for the secret of why light cigarette smokers must puff harder.]

As prominent tobacco researcher N.L. Benowitz wrote in a National Cancer Institute (NCI) monograph:

“In brief review—when faced with lower yield cigarettes, smokers can smoke more cigarettes per day, can take more and deeper puffs, can puff with a faster draw rate, and/or can block ventilation holes. Using these last four techniques, a smoker can increase his or her smoke intake from a particular cigarette several fold above the machine-predicted yields.”

In the description of a patent for a low-tar and low-nicotine technique in 1995, Duke University Researchers wrote:

“Unfortunately, it has been discovered that only a small proportion of the total smoking population (e.g., less than 25%) has substituted low tar cigarettes (e.g., cigarettes that deliver less than 10 milligrams of tar) for conventional and more hazardous cigarettes. Also of note, only about 2.0-3.0% of total cigarette sales are accounted for by very low tar cigarettes (e.g., cigarettes that deliver less than 3 milligrams of tar). Moreover, even among the cigarette smokers who have substituted low tar cigarettes for conventional cigarettes, it has been discovered that these individuals will tend to smoke low tar cigarettes more intensively in order to extract more tar and nicotine than the nominal values listed on the pack. This, of course, defeats part of the objective of the low tar cigarettes.”|

Moreover, there has never been any significant body of evidence to suggest that switching to lights or ultra-lights in a way actually contributes to the success of smoking cessation efforts. According to the National Cancer Institute, there are no health benefits for smokers of light cigarettes, period.

In a letter published in the August 21 issue of Science, Marshall E. Deutsch argues that cigarettes with reduced nicotine may in fact “increase tobacco related death and disease” and are therefore potentially more dangerous than regular smokes.

Deutsch’s argument is that by smoking more cigarettes with lower concentration of nicotine, smokers “will be subjected to more of the ‘tars’ (the cancer-causing ingredients of the smoke) in their attempts to get their usual dosage of nicotine, (the ingredient responsible for heart disease and stroke). In the end, smokers of low-nicotine cigarettes will remain at the same risk for heart disease and stroke but increase their chances of developing cancer.”

It’s never too late to quit, and the earlier the better: The National Cancer Institute tells us that smokers who quite before age 50 cut their risk of dying by 50 % over the next 15 years, compared to those who keep smoking.

Graphics Credit: www.tobaccoinaustralia.org.au

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The Portuguese Experiment

2009-09-09T12:07:00.004-05:00

How has decriminalization fared in Portugal?

In 2001, amid lurid worldwide media coverage, Portugal made the decision to eliminate penalties for the personal use and possession of heroin, cocaine, and marijuana. Dire predictions were heard on all sides. According to the London Economist, this “ultraliberal legislation had set alarm bells ringing across Europe. The Portuguese were said to be fearful that holiday resorts would become dumping-grounds for drug tourists. Some conservative politicians denounced the decriminalization as 'pure lunacy'”.

Strictly speaking, Portugal did not legalize drugs. They decriminalized them—drug use and possession have been deemed administrative, not criminal, matters. Drug trafficking remains a criminal offense. Portugal is the only nation in the European Union (EU) to have made this blanket move, and Portuguese health officials have been at pains to point out that decriminalization in Portugal does not mean that drug use is in any way condoned or encouraged there.

Eight years down the road, how is this "lunatic" project faring? According to the Cato Institute, in a report issued earlier this year, pretty darn well. In “Drug Decriminalisation in Portugal: Lessons for Creating Fair and Successful Drug Policies,” Glenn Greenwald concludes that the project is in fact “a resounding success.” According to the Cato report, “decriminalization has had no adverse effect on drug usage rates in Portugal, and that “sexually transmitted diseases and deaths due to drug usage” have decreased dramatically.

Two years earlier, a study by the British Beckley Foundation, a member of the International Drug Policy Consortium (IDPC), reported that the main changes in Portugal since decriminalization in 2001 were:

--Increased use of cannabis.

--Decreased use of heroin.

--Increased use of treatment options.

--Reduction in drug-related deaths.

The Economist, in its article entitled “Treating, Not Punishing,” concludes: “The evidence from Portugal since 2001 is that decriminalisation of drug use and possession has benefits and no harmful side-effects.”

No harmful side effects? How do we square that with the worldwide unending Drug War? I am tempted to suggest that either everybody is lying about the situation in Portugal, or else it is time to put the Drug War to bed. Drug Czar Gil Kerlikowske has made clear his distaste for the term “drug war,” but has yet to solidly indicate the course that will take the country away from spending money on interdiction and prosecution and toward spending money on treatment, medical research, and harm reduction policies.

Graphics Credit: Cato Institute

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National Alcohol and Drug Addiction Recovery Month

2009-09-03T11:36:00.004-05:00

Obama's September proclamation.

Recovery Month, an annual September observance highlighting the benefits of substance abuse treatment, kicked off on August 31 when President Obama issued a proclamation, excerpted below:

"Every year, Americans across the country overcome their struggles with addiction. With personal determination and the support of family and friends, community members, and health professionals, they have turned the page on an illness and sought the promise of recovery.

"As a Nation, we must work together to provide access to effective services that reduce substance abuse and promote healthy living. Without effective treatment, abuse of alcohol, illicit drugs, or prescription medications can devastate the mind and body. With treatment, substance use disorders can be managed, giving individuals the effective tools necessary to address their addiction.

"During National Alcohol and Drug Addiction Recovery Month, we also pay special tribute to the dedicated professionals and everyday citizens who, with skill and empathy, guide people through the treatment and recovery process. Across America, they are offering a message of hope and understanding. These compassionate individuals remind us that the strength of our character derives not from the mistakes we make, but from our ability to recognize and address them."

More information on Recovery Month is available HERE.

This year's theme--"Join the Voices for Recovery: Together We Learn, Together We Heal"-- is intended to "emphasize the need to use all available resources, in our communities and on the Internet, to educate people about the disease and to help those with substance use disorders, and those close to them, get support," according to the Recovery Month website.

The U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration (SAMHSA) and its Center for Substance Abuse Treatment (CSAT) created the materials being distributed for Recovery Month. President Obama's proclamation is available HERE.

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My Interview with Santa Fe Public Radio

2009-08-30T20:55:00.010-05:00

Addiction science gets a little air time.

Been doing some publicity for my book, The Chemical Carousel. This radio interview with Diego Mulligan on KSFR in Santa Fe is from August 26th, and it turned out to be reasonably listenable.

The interview runs 18 minutes.

CLICK HERE FOR THE INTERVIEW.

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My Name is Roger

2009-08-27T20:12:00.003-05:00

A famed movie critic tells his story.

Excerpted from :
“My Name is Roger, and I'm an alcoholic.”
By Roger Ebert, Chicago Sun Times
Posted on “Roger Ebert’s Journal,”
August 25, 2009.
© Sun-Times News Group

In August 1979, I took my last drink. It was about four o'clock on a Saturday afternoon, the hot sun streaming through the windows of my little carriage house on Dickens. I put a glass of scotch and soda down on the living room table, went to bed, and pulled the blankets over my head. I couldn't take it any more.
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At about this time I was reading The Art of Eating, by M. F. K. Fisher, who wrote: "One martini is just right. Two martinis are too many. Three martinis are never enough."
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In my case, I haven't taken a drink for 30 years, and this is God's truth: Since the first A.A. meeting I attended, I have never wanted to. Since surgery in July of 2006 I have literally not been able to drink at all. Unless I go insane and start pouring booze into my g-tube, I believe I'm reasonably safe. So consider this blog entry what A.A. calls a "12th step," which means sharing the program with others. There's a chance somebody will read this and take the steps toward sobriety.
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I know from the comments on an earlier blog that there are some who have problems with Alcoholics Anonymous. They don't like the spiritual side, or they think it's a "cult," or they'll do fine on their own, thank you very much. The last thing I want to do is start an argument about A.A.. Don't go if you don't want to. It's there if you need it. In most cities, there's a meeting starting in an hour fairly close to you. It works for me. That's all I know. I don't want to argue with you about it.
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I've been to meetings in Cape Town, Venice, Paris, Cannes, Edinburgh, Honolulu and London, where an Oscar-winning actor told his story. In Ireland, where a woman remembered, "Often came the nights I would measure my length in the road." I heard many, many stories from "functioning alcoholics." I guess I was one myself. I worked every day while I was drinking, and my reviews weren't half bad. I've improved since then.
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The God word. The critics never quote the words "as we understood God." Nobody in A.A. cares how you understand him, and would never tell you how you should understand him. I went to a few meetings of "4A" ("Alcoholics and Agnostics in A.A."), but they spent too much time talking about God. The important thing is not how you define a Higher Power. The important thing is that you don't consider yourself to be your own Higher Power, because your own best thinking found your bottom for you.

Photo Credit: chicagoist.com

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Heroin for Heroin Addiction

2009-08-25T11:53:00.005-05:00

Getting your fix at the doctor’s office.

A group of Canadian researchers has demonstrated the truth of a practice commonly used in European countries like The Netherlands and Switzerland: Heroin can be an effective treatment for chronic, relapsing heroin addicts. Published in the New England Journal of Medicine, the study is “the first rigorous test of the approach performed in North America,” according to a New York Times article by Benedict Carey.

In the study, 226 patients were randomly assigned to oral methadone therapy or injectable diacetylmorphine, the primary active ingredient in heroin, over a 12-month period. The “rate of retention in addiction treatment” was 88 percent for the diacetylmorphine group, compared to 54 percent for the methadone group. The “reduction in rates of illicit-drug use” was 67 percent for the heroin group and 48 percent for the methadone group.

Using doctor-prescribed heroin has two advantages, some researchers believe. It gets around the problem of addicts who don’t like the effect of methadone and therefore don’t take it as prescribed. Moreover, as European countries have demonstrated, it brings treatment-resistant opiate addicts into regular contact with physicians and medical treatment professionals, thereby keeping them away from drug dealers and out of jail.

The downside is equally obvious. It keeps addicts hooked on heroin, and may even exacerbate their addiction by providing a higher quality drug. Furthermore, it runs against the prevailing North American notion that heroin should be illegal, period. Certainly, doctors have no business prescribing it to active addicts, critics argue. Furthermore, the risk of overdose or seizure is always present.

According to senior author Martin Schechter of the University of British Columbia’s School of Population and Public Health, as quoted in the New York Times: “The main finding is that for this group that is generally written off, both methadone and prescription heroin can provide real benefits.”

In an editorial accompanying the journal article, Virginia Berridge of the London School of Hygiene and Tropical Medicine cautioned that “the rise and fall of methods of treatment in this controversial area owe their rationale to evidence, but they also often owe more to the politics of the situation.”

At the end of the 19th Century in America, opium was widely prescribed as a cure for alcoholism. For opium addiction, the treatment was often alcohol.

Photo Credit: www.steps2rehab.com

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Who are Cocaine’s Primary Victims?

2009-08-22T14:56:00.007-05:00

The answer may surprise you.

They are not necessarily the poor, the desperate, or the weak-willed. A National Institute of Drug Abuse (NIDA) study by Dr. Michael Nader and coworkers at Wake Forest University demonstrates that they are likely to be people with innately low levels of dopamine receptor availability. This flaw, possibly genetic, renders them more sensitive to the rewarding effects of cocaine. Put simply: Individuals with less dopamine naturally available in the brain may have an inherited predisposition for cocaine addiction. [Brains Scans at right: Dopamine receptor availability in yellow falls markedly after 6 and 12 months of cocaine self-administration.]

Dopamine D2 receptors, a crucial part of the brain’s primary reward system, are normally occupied by dopamine molecules—although at any given moment, many of the receptors are empty and remain available until a stimulus like cocaine increases dopamine levels and the empty receptors help mop up the excess. Dr. Nader believes that lower D2 receptor availability could be a precursor of addiction to drugs like cocaine. “Perhaps an individual with low availability gets a greater kick from cocaine because the drug-induced dopamine release stimulates a greater percentage of their receptors,” Dr. Nader told staff writer Lori Whitten in a recent edition of NIDA Notes. “Another possibility is that the drug prompts some individuals’ brain cells to release dopamine in particularly high quantities that are sufficient to fill the great majority of vacant D2 receptors, and this augments the high.”

An obvious question hangs over studies of this kind: Are the D2 receptor differences innate, or do they represent changes induced by drug use? To answer this question, Dr. Nader’s team worked with rhesus monkeys in order to take D2 density measurements with PET scans before the animals had ever been exposed to cocaine. Sure enough, the monkeys with the lowest baseline level of D2 receptor availability went on to self-administer cocaine at much higher rates than their D2-normal compatriots. Offering food to the low-dopamine animals did not prove to be a substitute of cocaine, so the effect does not appear to increase all kinds of reward.

There is no doubt that the use of cocaine itself does lead to a rapid reduction of available dopamine receptors, as the brain seeks to achieve a new equilibrium in the face of regular dosings of dopamine-active chemicals. In five monkeys that self-administered cocaine for a year, three of the monkeys showed a strong recovery of receptor availability after only a month of abstinence. However, two of the monkeys showed slower recovery of previous D2 receptor levels. Dr. Cora Lee Wetherington, a neuroscience researcher at NIDA, said that the research thus posed the question of whether people whose dopamine receptor levels recover more slowly during abstinence might prove to be those most likely to relapse.

Medications that increase D2 receptor availability without themselves being highly rewarding represent another promising avenue for treatment. The drugs most likely to help, Dr. Nader thinks, are drugs that act indirectly on dopamine levels through alterations of serotonin and GABA levels in the brain. In addition, researchers are pursuing environmental enrichment experiments in animals and human subjects. Some studies have shown that enriching the environment results in greater D2 receptor levels, Dr. Nader says.

Photo Credit: NIDA

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Rules for a Night of Serious Drinking

2009-08-20T22:46:00.004-05:00

Simple moves to dodge a hangover.

Let's face it: Despite all the folk remedies--ginseng, prickly pear extract, peanut butter, miso soup, and Vitamin B6, there really is no cure for a hangover except more alcohol.

However, there are things you can keep in mind when contemplating a night of serious drinking. What you do while you are drinking can mitigate or exacerbate the effects of the Day After. The following list was adapted from a post by the folks over at the Nursing Schools Network and Directory and used with their kind permission.

--If you're in it for the long haul, consider alternating an alcoholic beverage with a non-alcoholic drink. The reward for this is continual hydration, which helps offset the tendency of alcohol molecules to replace water molecules in the cells.

--Choose your liquor carefully. Red wine and cheap dark booze have more congeners, which are organic molecules that can contribute to a hangover. ML01, a genetically-modified yeast, is being touted as a way of cutting back on the headaches commonly associated with a night of red wine.

--Keep Count. When you lose count, it's time to stop. Know your measure.

--Skip the Sugar. Sweet drinks mess with your blood sugar level even more than regular drinks.

--Keep the smoking to a minimum. You'll need your oxygen come morning.

--Don't diss the bar and cocktail snacks. Foods high in fat well help absorb excess alcohol.

--Skip the Tylenol and Ibuprofen before going out. They probably won't help, and the combination with alcohol taxes the liver.

--Drink water. And keep drinking water. Morning-after dehydration causes many of a hangover's lingering effects.

--Stop drinking an hour before you go to bed. Better to nod off than to pass out, and you will have a better chance of sleeping through the night.

Picture Credit: www.ehow.com

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