Heroin treatment the answer for hardcore opiate addiction?

Following is a piece I recorded on Supervised Injectable Heroin Treatment which airs on the Drug Truth Network's 420 News segment May 6, 2012. The audio file can be downloaded from here.

The federal government and several state Attorneys General are sounding the alarm over heroin use and prescription painkiller addiction. Their approach is more of the same: more law enforcement, more drug testing, and more propaganda. Outside the US, more enlightened approaches are proving effective. The research overall shows substitution treatment with methadone or buprenorphine to be highly effective for those dependent on opiates. Availability of Methadone Maintenance Treatment must be expanded. Still, there are hardcore addicts for whom even methadone fails. What do we do about them? One possible answer: Supervised Injectable Heroin treatment. It's controversial, yet the evidence of its effectiveness in all areas continues to mount. The European Union's drug agency, the European Monitoring Centre on Drugs and Drug Addiction, recently published a review of the literature around heroin treatment. Overall, they concluded: Quote: “Over the past 15 years, six Randomized Controlled Trials have been conducted involving more than 1500 patients, and they provide strong evidence, both individually and collectively, in support of the efficacy of treatment with fully supervised self-administered injectable heroin, when compared with oral Methadone Maintenance Treatment, for long-term refractory heroin-dependent individuals.” End quote. Among other things they found that, quote: “Across the trials, major reductions in the continued use of ‘street’ heroin occurred in those receiving Supervised Injectable Heroin compared with control groups (most often receiving active Methadone Maintenance Treatment).” End quote. And, quote: “Reductions in the criminal activity of Supervised Injectable Heroin patients were evident and were substantially greater when compared with patients under control conditions.” End quote. Most importantly, quote: “Finally, countries that have conducted longer term (up to six years) follow-up studies have seen a high retention in Supervised Injectable Heroin (55 % at two years and 40 % at six years), with patients sustaining gains in reduced ‘street’ heroin use and marked improvements in social functioning (e.g. stable housing, drug-free social contacts and increased rate of employment).” End quote. In the US, where methadone is still considered controversial in some communities and treatment availability is thus quite limited, Supervised Injectable Heroin treatment will seem like a radical approach – yet it works. The question is, how long do we keep doing more of the same, and failing, before we try a different way? For the Drug Truth Network, this is Doug McVay with Common Sense for Drug Policy.

Berkeley pot dispensary biggest casualty of federal crackdown | California Watch

I'm quoted accurately in this story. The reporters have much more info which they have yet to report - I save all kinds of paper, email, IMs, texts, etc. Just saying, they really should have let me take time off to take care of my dying mother back in Iowa. Not that I'm bitter .......

Berkeley pot dispensary biggest casualty of federal crackdown | California Watch

Audio File for 'Pain, Malingering, and the Real Question'

The audio file for my piece "Pain, Malingering, and the Real Question" from the Drug Truth Network's 420 Newsbriefs is available here.

Pain, Malingering, and The Real Question

Following is the text of an audio piece I just put completed for the Drug Truth Network. I'll post a link to the audio file when it's aired.

Throwing out the baby with the bathwater.

The federal government continues its assault on medical cannabis with recent DEA raids in Oakland, threatening letters sent to landlords in Oregon, and indictments in Montana. A candidate for state Attorney General in Oregon makes criticism of the state's medical marijuana program part of his campaign rhetoric, calling it a quote “train wreck” end quote, because so many patients in the program have only chronic serious pain as their qualifying condition.

On another front, the federal government is warning of an epidemic of painkiller addiction, threatening doctors for prescribing adequate medication for their patients and pushing some pain sufferers into illicit drug use, treatment, or prison.

These drug control policy stories aren't only about drug policies. Ultimately this is about pain, and the question of whether pain is real. Pain is regarded by many as a legitimate treatable condition, by others as a subjective and difficult to measure symptom, yet it is viewed by some as an illusory complaint used by the weak and the lazy to excuse their lack of will.

Most of us would regard that latter opinion as unthinking and cruel, though inhuman and barbaric are clean enough for radio and probably cleave closer to the mark.

Yet, the fact is that some people do malinger. Research on how many people try to fake illness, injury, pain or disability has yielded mixed results. Estimates of malingering range from as low as 1-10% to as high as 20-40%. As with so many tough questions, reality may lie somewhere inbetween.

But if you think those sound like big numbers, check these out: According to the federal Institute of Medicine, quote “chronic pain affects about 100 million American adults – more than the total affected by heart disease, cancer, and diabetes combined. Pain also costs the nation up to $635 billion each year in medical treatment and lost productivity.” End quote. That 100 million estimate leaves out those who suffer short-term serious acute pain for example because of injury or a sudden serious illness such as cancer.

A few cases may be exaggerated, some go untreated, and yet all of them are targeted by federal and corporate bureaucracies which view pain as a moral failing and a sin against business. It's time for change.

For the Drug Truth Network, this is Doug McVay with Common Sense for Drug Policy.

Consequences - New Audio for the Drug Truth Network

This is a segment I recorded for the Drug Truth Network. It's being broadcast on March 20, 2012, and is available here.

Consequences Erica Dinerman is project manager for Natick Together for Youth, a substance abuse prevention project of Natick, MA Public Schools. The MetroWest Daily News on March 15 published a letter from her office urging voters to oppose a medical marijuana legalization initiative which has not yet made it to the November 2012 general election ballot. Ms. Dinerman began her letter by noting that her program was the recipient of a new Drug Free Communities Grant of $625,000 over a five-year period. That's 125,000 of our tax dollars each year for the next five years. Ms. Dinerman made clear that the focus of those tax dollars in the first year was opposing a medical marijuana initiative in Massachusetts. According to ONDCP, state and local agencies – like Natick Public Schools – and their officers and employees – like Ms. Dinerman - must abide by the same Hatch Act restrictions against political involvement which federal employees must obey. Unfortunately, the Hatch Act does not restrict involvement in initiative and referenda campaigns, in fact they are specifically exempted. So it's legal. The Hatch Act concern is merely a technicality, however. Let's get to the real meat of the story. According to ONDCP, Drug Free Community grants are for the purpose of preventing youth substance use. On her website, Ms. Dinerman asserts that medical marijuana laws mean increased youth use. It's not true, though young people and adults are more likely to admit using marijuana once penalties are reduced because they feel less afraid of admitting the truth, but nuances seem lost on Ms. Dinerman. To Ms. Dinerman, concerns like alcohol, tobacco, inhalants, and prescription drugs – the youth drug use concerns which most schools face – seem to pale in significance compared with adult use of medical marijuana by physician-authorized patients. Is this what the parents in the Natick Public School system consider their biggest threat? It's certainly not what real prevention professionals would call effective use of very limited federal funds. Some people might even call it sleazy and unethical. At the end of the day the ones who will suffer most are the students in Natick Public School system. Ms. Dinerman does seem to be concerned with consequences. She used the word four times in her 290 word letter. One can only hope Ms. Dinerman will learn the consequences for misusing limited federal resources in this way – if not in real court, then at least in the court of public opinion. For the Drug Truth Network, this is Doug McVay, Common Sense for Drug Policy.

Audio file posted for If someone you love can't sleep, drug 'em

As promised below (If someone you love can't sleep, drug 'em) here's a link to the audio file of an item I recently put together for the Drug Truth Network about veterans, PTSD, and pain meds. It's being used in the 4:20 news segment on March 12.

A War on Pain Relief

This is an audio piece I did for the 4:20 News to be broadcast on Sunday, March 11, via the Drug Truth Network.

03/11/12 Doug McVay | Drug Truth Network

Here's a transcript:

Throwing out the baby with the bath water

US Drug Czar Gil Kerlikowske testified before a House Subcommittee on February 29. The Czar appeared on a panel testifying alongside attorneys general from Florida and Kentucky, all of them urging tougher action against prescription drug misuse and abuse. The Czar declared that problems of prescription drug abuse had grown to a national crisis which until recently had not been quote “on the radar screen” end quote.

Oh really?

A federal crackdown on pain management specialists and pain patients has gone on since at least 2001, when hysteria over OxyContin was making headlines across the country. Much of what was reported was hype, yet it resulted in a lot of pain – literally – for many people.

In December 2007, Drug Czar John Walters from the White House press room announced the release of new Monitoring the Future data showing that prescription drug misuse and abuse among young people was still on the increase.

In 2011, the DEA held its 20^th annual conference on pharmaceutical and chemical diversion. Two Zero, this year will be the 21^st.

Why does this matter? According to the CDC's report Health United States 2010, 30 percent of adults over 18 surveyed reported suffering joint pain within the past 30 days. Most disturbingly according to the CDC, quote “even for patients enrolled in a hospice care program that has the stated purpose of making the dying process more comfortable, one-third of decedents had pain near the time of death.” end quote.

While there is no question that diversion does occur, and that opioids are powerful and potentially addictive, there is also no question that many Americans suffer with pain. The chilling effect of the crackdown on pain relief means that many will continue to needlessly suffer. Let's not throw the baby out with the bath water. It's time to flip the script.

For the Drug Truth Network, this is Doug McVay, Common Sense for Drug Policy.

If someone you love can't sleep, drug 'em

(This is a piece I just did for the Drug Truth Network. I'll post a link to the audio file when it's available.)
An old friend once wrote, If someone you love can't sleep, drug them.

Veterans Administration hospitals seem to be following his advice, and not in a good way. At least that seems to be the conclusion of researchers who looked into treatment of American veterans of the Iraq and Afghanistan wars.

According to a report in the March 7, 2012 edition of the Journal of the American Medical Association, veterans diagnosed with a pain condition who were also diagnosed with Post Traumatic Stress Disorder were nearly three times as likely to receive opiate pain medicines as those with a pain diagnosis who did not have a diagnosis of a mental health disorder. These vets with both PTSD and pain diagnoses were 1.5 times as likely to be prescribed opiate pain meds as vets diagnosed with both pain and a mental health disorder other than PTSD.

Further, veterans with PTSD and pain were more likely to receive higher-dose opioids, to receive two or more opioids concurrently, to receive sedative hypnotics concurrently, and to obtain early opioid refills. These patients also faced an increased risk of quote “adverse clinical outcomes” end quote.

We also know that vets with PTSD are already at high risk for substance abuse.

The Multidisciplinary Association for Psychedelic Studies are researching the effectiveness of the drug ecstasy, otherwise known as MDMA, in treating PTSD among vets. Their efforts are making progress, slowly yet surely. No matter how we may feel about the wars our politicians wage, we all owe it to our veterans to help them recover from their wounds and their experiences and to provide them effective therapy, rather than just tranquilizing them and keeping them out of the way.

For the Drug Truth Network, this is Doug McVay with Common Sense for Drug Policy.

NORML’s Official Reply To ‘Patients Against I-502’

NORML’s Official Reply To ‘Patients Against I-502’

by Allen St. Pierre, NORML Executive Director
February 24, 2012

NORML supports (and publicly endorses when requested by the principal organizers) marijuana legalization, regulation, and medical use initiatives that qualify for the state ballot, so long as they move us closer to full legalization, even if they contain provisions we do not believe should be included in a perfect proposal.

Every cannabis law reform initiative dating back to the 1972 proposal in CA has included some flaws, but nonetheless when the initiatives have been approved, marijuana consumers, (including those who use cannabis for medical reasons) benefit by legal protections that did not exist under prior law.

When any marijuana law reform initiative qualifies for the ballot, it instantly creates a much needed public policy discussion and debate about the need to end cannabis prohibition. The mainstream media, editorial boards, columnists and radio talk shows FINALLY start to focus on the problems created by 74 years of prohibition and the benefits of alternative public policies.

The value of this public discussion, even if the initiative loses, clearly moves us closer to eventual victory. For example, Prop. 19 in CA, which ended up getting nearly 47% of the vote, sparked a national debate over the merits of legalization that helped move the support for full legalization to the highest point ever, measured by a recent Gallup poll as 50% support nationwide.

At NORML, we support these efforts, even when imperfect, because the greater good achieved by legalization proposals outweighs the imperfect language; and what flaws exist in individual initiatives can be amended in future legislation (or if necessary, via another voter initiative). But in the meantime, tens of thousands of marijuana arrests are avoided by the new law.

We fully recognize the per se DUI marijuana provisions in I-502 are arbitrary, unnecessary, and unscientific, and we argued strongly with the sponsors for provisions that would require proof of actual impairment to be shown before one could be charged with a traffic safety offense. NORML, arguably more so than any other drug law reform organization, has a long track record of opposing the imposition of arbitrary and discriminatory per se traffic safety laws for responsible cannabis consumers. But we failed to persuade the sponsors of I-502, and now we must decide whether to support the initiative despite those provisions. We believe the overall impact of this proposal, if approved by voters this fall and enacted, will be overwhelmingly helpful to the vast majority of cannabis consumers in the state, and will eliminate tens of thousands of cannabis arrests each year. Thus, NORML’s Board of Directors voted unanimously (including the two members from WA) to endorse the initiative, while maintaining our opposition to per se DUID provisions in principal.

Additionally, at NORML we also support the right of consumers to grow their own marijuana, and there is no such legal protection in the WA initiative. However, qualified patients already protected under existing law will be able to continue to grow cannabis, as I-502 does not alter existing medicinal cannabis laws. The sponsors found through their polling that the inclusion of the right to cultivate marijuana for personal adult use would reduce their level of public support below that needed for approval. Again, while we continue to support personal cultivation, we believe the initiative still deserves our support, despite this calculated omission by I-502’s sponsors.

We would urge those who support marijuana legalization, but oppose specific provision of I-502, to nonetheless support this initiative because of the importance of 1.) having one state actually approve legalization and confront the federal government on this issue, and 2.) stopping thousands of expensive and damaging arrests, prosecutions and incarcerations annually in WA for cannabis-related offenses, notably for simple possession.

For those who feel they cannot support the current initiative, because it is not perfect, we would hope they would step aside and take no public position, in order not to undermine what is an historic opportunity to end marijuana prohibition, by popular vote, under state law.

Testing Fever Hits the Potomac Again

Two stories caught my eye this week.

The first has to do with Congress jumping back onto the drug war bandwagon by adopting a law to force states to require that many people seeking unemployment compensation first pass a urine drug test. The Fiscal Times reported on Feb. 19, 2012:

Drug testing for some unemployed: The legislation encourages states to enact legislation to require applicants for unemployment insurance to pass a drug test under the following conditions: 1) the individual was fired from his or her most recent job because of the unlawful use of controlled substances, or 2) the individual’s only suitable work involves employment in an occupation that regularly conducts drug testing.

from 8 Things You Didn't Know About Payroll Tax Cut Deal, by ERIC PIANIN, The Fiscal Times, Feb. 19, 2012.

Such programs have been shown to be a waste of time and taxpayer money. In spite of this, three states have enacted or are trying to enact such a testing program, as noted by AP on Feb. 15:

Those who failed drug tests would face a series of progressively strict penalties. A welfare applicant would be ineligible for financial assistance for one month after failing a first drug test. A second failed test would cut off funding for three months, while a third failed test would eliminate an applicant's welfare funding for three years.

Similar legislation was filed in 36 states last year, but passed only in Arizona, Florida and Missouri. A federal judge blocked Florida's program pending a lawsuit there. Tarren Bragdon, chief executive officer of the Foundation for Government Accountability, backed Spencer's bill, saying that Florida saw a nearly 50 percent drop in approvals during the brief period when the tests were allowed.

From AP: Bill on Testing Welfare Recipients Slowed, Feb. 15, 2012.

If the FGA's mouthpiece quoted above was correct, that's a very scary number because the testing program itself, as the Tampa Tribune reported on Aug. 24, 2011:

Since the state began testing welfare applicants for drugs in July, about 2 percent have tested positive, preliminary data shows.

Ninety-six percent proved to be drug free -- leaving the state on the hook to reimburse the cost of their tests.

The initiative may save the state a few dollars anyway, bearing out one of Gov. Rick Scott's arguments for implementing it. But the low test fail-rate undercuts another of his arguments: that people on welfare are more likely to use drugs.

And oops, looks like the mouthpiece from the FGA was wrong after all - surprise surprise:

Having begun the drug testing in mid-July, the state Department of Children and Families is still tabulating the results. But at least 1,000 welfare applicants took the drug tests through mid-August, according to the department, which expects at least 1,500 applicants to take the tests monthly.

So far, they say, about 2 percent of applicants are failing the test; another 2 percent are not completing the application process, for reasons unspecified.

Cost of the tests averages about $30. Assuming that 1,000 to 1,500 applicants take the test every month, the state will owe about $28,800-$43,200 monthly in reimbursements to those who test drug-free.

That compares with roughly $32,200-$48,200 the state may save on one month's worth of rejected applicants.

The savings assume that 20 to 30 people -- 2 percent of 1,000 to 1,500 tested -- fail the drug test every month. On average, a welfare recipient costs the state $134 in monthly benefits, which the rejected applicants won't get, saving the state $2,680-$3,350 per month.

But since one failed test disqualifies an applicant for a full year's worth of benefits, the state could save $32,200-$48,200 annually on the applicants rejected in a single month.

Net savings to the state -- $3,400 to $8,200 annually on one month's worth of rejected applicants. Over 12 months, the money saved on all rejected applicants would add up to $40,800-$98,400 for the cash assistance program that state analysts have predicted will cost $178 million this fiscal year.

From Welfare drug-testing yields 2% positive results By CATHERINE WHITTENBURG, The Tampa Tribune, Aug. 24, 2011.

Another testing story probably passed below the radar for most folks, which is too bad because this one will affect a lot more people and could have some very serious repercussions. AP's Garance Burke reported on Feb. 19, 2012:

The budget plan the president sent to Congress Monday would ax the Agriculture Department’s tiny Microbiological Data Program, which extensively screens high-risk fresh produce throughout the year for bacteria including salmonella, E. coli and listeria.

If samples are positive, they can trigger nationwide recalls, and keep tainted produce from reaching consumers or grocery store shelves.

Food safety advocates and a top-ranking U.S. Centers for Disease Control and Prevention official said the information also can help pinpoint foods tied to illness outbreaks, and would not easily be replaced by companies’ internal tests or more modest federal sampling programs.

Yet how serious a problem is contaminated food in this, our 21st century America?

Last year, for instance, California firms recalled pre-packaged fresh cilantro and bagged spinach from the marketplace after MDP tests of random samples detected salmonella.

According to the CDC, nearly one-third of the major, multistate foodborne illness outbreaks in 2011 were caused by contaminated fruits and vegetables.

The 120,000 food samples the program has collected in the last decade have offered public health officials important clues when they are probing the source of food poisoning outbreaks, Dr. Robert Tauxe, the CDC’s top food-germ investigator, said in an interview in October when the agency began offering the program’s employees early retirement packages.

Last year, the program found lettuce and spinach contaminated with E. coli O157:H7, the strain most commonly responsible for food poisoning, and also started aggressively testing for listeria in cantaloupes in response to the nation’s most deadly foodborne illness outbreak, in which 30 people died after eating listeria-tainted melons. In one instance in the last several years, a contaminated produce sample the program identified was later tied to an illness cluster, Tauxe said.

FDA Produce Safety Staff Director Samir Assar said in an October interview that while his agency also conducts targeted tests of certain high-risk fresh fruits and vegetables each year, cutting MDP would leave the regular testing of sprouts, tomatoes, cantaloupe and cilantro to industry and more modest state and federal efforts.

But surely there are other agencies at the federal level, or in the states? WRONG.

FDA spokeswoman Siobhan DeLancey, however, said she could not speculate on whether FDA would set up a parallel program, or had the money to do so.

“We don’t test produce,” said Lola Russell, a CDC spokeswoman. “That’s just not part of our mission.”

State health departments are already facing tough choices as they try to come up with enough dollars to keep food safe after tens thousands of employees have been laid off in recent years. And the FDA has always been crunched for food safety dollars, receiving so little money for food inspections that some facilities are only inspected every five to 10 years. A new food safety law President Obama signed last year aims to increase the number of inspections in the United States and abroad, but emphasizes prevention rather than increased testing of foods.

From Obama's Budget Cuts Bacteria Testing in Produce, by GARANCE BURKE, AP, Feb. 19, 2012.

Major investigative report from The Bangkok Post: Myanmar's Rising Drug Trade

From the story:

"Critics say that the ceasefire agreements signed with ethnic armies are driven by a desire to capitalise on the country's booming narcotics business not a desire for change and that the army and politicians are padding their coffers with the proceeds."

More here: http://www.bangkokpost.com/news/investigation/279434/myanmar-reforms-mask-meteoric-rise-in-drug-trade

Data-Free Scare Story Of The Week: Meth Fills Hospitals With Burn Patients

This week's well-hyped scare story seems to be about illicit methamphetamine production and use filling hospitals across the country with accident and burn victims and putting a heavy strain on burn units.

Really? Sounds scary. According to this Jan. 23, 2012 AP news story:

A crude new method of making methamphetamine poses a risk even to Americans who never get anywhere near the drug: It is filling hospitals with thousands of uninsured burn patients requiring millions of dollars in advanced treatment — a burden so costly that it's contributing to the closure of some burn units.

Wow. It's not closures due to corporate takeovers, or that hospitals are cutting spending by cutting back on emergency care and care for the indigent. It's meth.

Read on:

An Associated Press survey of key hospitals in the nation's most active meth states showed that up to a third of patients in some burn units were hurt while making meth, and most were uninsured. The average treatment costs $6,000 per day. And the average meth patient's hospital stay costs $130,000 — 60% more than other burn patients, according to a study by doctors at a burn center in Kalamazoo, Mich.

The influx of patients is overwhelming hospitals and becoming a major factor in the closure of some burn wards. At least seven burn units across the nation have shut down over the past six years, partly due to consolidation but also because of the cost of treating uninsured patients, many of whom are connected to methamphetamine.

Ah. So, it is due to corporate takeovers and cutting services to indigents and the un-/under-insured.

Surely there are some statistics somewhere in this story. Aren't there?

Few people burned by meth will admit it.

"We get a lot of people who have strange stories," said Dr. David Greenhalgh, past president of the American Burn Association and director of the burn center at the University of California, Davis. "They'll say they were working on the carburetor at 2 or 3 in the morning and things blew up. So we don't know for sure, but 25 to 35% of our patients are meth-positive when we check them."

Guy cited a similar percentage at Vanderbilt, which operates the largest burn unit in Tennessee. He said the lies can come with a big price because the chemicals used in meth-making are often as dangerous as the burns themselves.

He recalled the case of a woman who arrived with facial burns that she said were caused by a toaster. As a result, she didn't tell doctors that meth-making chemicals got into her eyes, delaying treatment.

Okeh, not so far, but buried deep in the story we read this:

In Indiana, about three-quarters of meth busts now involve shake-and-bake. And injuries are rising sharply, mostly because of burns, said Niki Crawford of the Indiana State Police Meth Suppression Team.

Indiana had 89 meth-related injuries during the 10-year period ending in 2009. The state has had 70 in the last 23 months, mostly from shake-and-bake labs, Crawford said.

At last, some numbers. Yet, 70 injuries over a nearly 2-year period - in a state which reported some 1,346 clandestine lab incidents and 1,212 lab arrests in 2010 - doesn't sound like it translates into thousands across the US.

Another problem is the period to which this is being compared. The state of Indiana's law enforcement focus on methamphetamine has grown dramatically over the past decade, as shown by that same report by the state of Indiana: 314 lab incidents and 248 arrests in 2000, growing to 1,011 incidents and 860 arrests in 2003, dropping to 766 incidents and 530 arrests in 2007, after which the numbers again begin to climb.

To clarify: I agree that methamphetamine is a nasty drug, and that illicit manufacture and trafficking is a serious concern. I object to scare stories and fear-mongering because rational debate and intelligent, reasonable policies are never forged in a climate of hysteria.

In terms of policy, we have to make more broadly available effective treatment for meth addiction, probably including substitution treatment. See for example this 2010 review of research published in the Annals of the NY Academy of Sciences, Agonist-like pharmacotherapy for stimulant dependence: preclinical, human laboratory, and clinical studies. According to the authors:

Stimulant abuse/dependence should be examined with the view that there may be recurring episodes of variable severity, that return to use might be diminished by agonist-like medications, and that in any case a range of medications should be available. Although stimulant abuse and dependence have substantial risks, ample data indicate that wellmonitored regimens of stimulants for ADHD, narcolepsy, as well as substance abuse treatment, are relatively safe and have a favorable risk–benefit ratio. Conversely, although there has been extensive examination of other medications, such as anticonvulsants or antagonists (usually antipsychotics), results have been disappointing and, like any medication, these agents have significant risks and adverse consequences aswell.With thewide variability in stimulant use patterns and their effects, medication administration should be predicated on a continuum of severity. No single agent will be the panacea for the spectrum of patients. This parallels the differential response to SSRIs across depressed patients; it is poorly understood but clinically apparent. The data and conceptualization suggest that a range of agonist-like agents, from modest to robust, should be explored. At times, stimulant abuse/dependencemay also require combinations of medications. Further, variation in severity of stimulant abuse/dependence, individual differences, and at times collateral conditions, whether acute (e.g., psychosis) or preexisting and enduring (e.g., depression), may dictate instances where several classes ofmedications will be essential for treatment, either briefly or for the long term. In sum, development of a range of agonist-like agents will result in better treatment for stimulant dependence.

Also check out this excellent journal article from Drug and Alcohol Review (2002) 21, 179-185, "Substitution therapy for amphetamine users":

At the beginning of the new millennium, amphetamine use is more prevalent and less easily controlled than ever before. Technological, cultural, social and economic change has driven a recent relentless worldwide expansion of amphetamine use. An incomplete understanding of the natural history of problematic amphetamine use and the more obvious short-term harms associated with heroin use may have delayed a comprehensive public health response to widespread amphetamine use. The advent of polydrug use has refocused public health attention towards effective treatments for amphetamine users, particularly dependent and injecting users. The efficacy of substitution therapy is not known, even though the practice appears to have gained a degree of clinical acceptance at least in the United Kingdom. The literature is not extensive and controlled trials are few. There is a strong and growing case for rigorous evaluation of substitution therapies combined with tailored psychosocial interventions to achieve improved outcomes for amphetamine users.

Happy Anniversary, Roe

January 23rd is the anniversary of landmark 1973 Supreme Court decision Roe v. Wade, that established a woman's basic right to make and control her own reproductive choices by allowing legal abortion, albeit within very tight restrictions.

Recently, the highly respected English medical journal The Lancet published a research article examining rates of abortions worldwide and estimating how many are unsafe. As noted in the abstract of "Induced abortion: incidence and trends worldwide from 1995 to 2008":

The global abortion rate was stable between 2003 and 2008, with rates of 29 and 28 abortions per 1000 women aged 15—44 years, respectively, following a period of decline from 35 abortions per 1000 women in 1995. The average annual percent change in the rate was nearly 2·4% between 1995 and 2003 and 0·3% between 2003 and 2008. Worldwide, 49% of abortions were unsafe in 2008, compared to 44% in 1995. About one in five pregnancies ended in abortion in 2008. The abortion rate was lower in subregions where more women live under liberal abortion laws.

The conclusions won't be welcomed by people who are anti-choice, though that does nothing to change the facts (emphasis has been added):

The substantial decline in the abortion rate observed earlier has stalled, and the proportion of all abortions that are unsafe has increased. Restrictive abortion laws are not associated with lower abortion rates. Measures to reduce the incidence of unintended pregnancy and unsafe abortion, including investments in family planning services and safe abortion care, are crucial steps toward achieving the Millennium Development Goals.

Sativex As Substitution Treatment for Cannabis Addicts?

The Associated Press reported on Jan. 22, 2012, that GW Pharmaceuticals is making progress in its efforts to gain FDA approval for use of its cannabis-based drug Sativex in the US. According to AP:

A British company, GW Pharma, is in advanced clinical trials for the world's first pharmaceutical developed from raw marijuana instead of synthetic equivalents— a mouth spray it hopes to market in the U.S. as a treatment for cancer pain. And it hopes to see FDA approval by the end of 2013.

Sativex contains marijuana's two best known components — delta 9-THC and cannabidiol — and already has been approved in Canada, New Zealand and eight European countries for a different usage, relieving muscle spasms associated with multiple sclerosis.

FDA approval would represent an important milestone in the nation's often uneasy relationship with marijuana, which 16 states and the District of Columbia already allow residents to use legally with doctors' recommendations. The U.S. Drug Enforcement Administration categorizes pot as a dangerous drug with no medical value, but the availability of a chemically similar prescription drug could increase pressure on the federal government to revisit its position and encourage other drug companies to follow in GW Pharma's footsteps.

"There is a real disconnect between what the public seems to be demanding and what the states have pushed for and what the market is providing," said Aron Lichtman, a Virginia Commonwealth University pharmacology professor and president of the International Cannabinoid Research Society. "It seems to me a company with a great deal of vision would say, 'If there is this demand and need, we could develop a drug that will help people and we will make a lot of money.'"

As broad as the market for medical cannabis products is currently, there are even more applications being researched which could significantly expand that market should Sativex gain approval. One example: Australia's National Cannabis Prevention and Information Centre is researching use of Sativex as substitution therapy for to help cannabis addicts quit using. The Sydney Morning Herald reported on Jan. 9, 2012 that:

SMOKERS have nicotine patches and heroin users have methadone but cannabis users have little choice except to go ''cold turkey'' if they want to kick their habit.

However, researchers at the University of NSW hope a cannabis-based mouth spray, prescribed to multiple sclerosis sufferers and not available in Australia, could be used to help people quit marijuana.

There are no products aimed at easing people off cannabis, the only option being rehabilitation where a cocktail of prescribed drugs is used to counteract withdrawal symptoms.

Here's a link to the NCPIC's news release on the research. According to NCPIC:

In a world-first, researchers from the National Cannabis Prevention and Information Centre (NCPIC), based at the University of New South Wales, are leading a study to determine whether the pharmaceutical drug Sativex can help people better manage cannabis withdrawal symptoms as a platform for ongoing abstinence.

It is estimated that there are at least 200,000 people dependent on cannabis in Australia, with one in ten people who try the drug at least once in their lifetime having problems ceasing use.

Remembering Newt

What I find hard to understand is how anyone can be treating news about Newt being a schmuck who has problematic personal relationships as, well, news. It's been known for a very long time. As one bit of evidence I present this Sept. 1995 article by Gail Sheehy from Vanity Fair, "The Inner Quest of Newt Gingrich." It is well worth a read. For example:

One of his first independent acts was to escape the totalitarian regime of his stepfather's home. He chose a path that women have used for generations: he made a jailbreak marriage, attaching himself at the tender age of 19 to his high-school geometry teacher, Jackie Battley --a buxom blonde seven years his senior. "He was her little boy," says Kit. [Kit Gingrich, Newt's mother]

and

Along with his amorphous political persona, Newt showed a propensity for the kind of behavior boys boast about in the locker room. Throughout his first campaign he was having an affair with a young volunteer. Dot Crews, who occasionally drove the candidate, says that almost everybody involved in the campaign knew. Kip Carter claims, "We'd have won in 1974 if we could have kept him out of the office, screwing her on the desk."

The Gingriches entered marriage counseling, but Newt continued to behave as if other people's rules didn't apply to him. Dot Crews observes, "It was common knowledge that Newt was involved with other women during his marriage to Jackie. Maybe not on the level of John Kennedy. But he had girlfriends --some serious, some trivial."

and especially:

During 1979 and 1980, Newt Gingrich --despite his political success-- entered a period of crisis. He almost, to borrow a phrase, "wiped out." "He went through a real down period, ducked his head, retreated from the battlefield," says Eddie Mahe. According to other sources, Newt was drinking heavily. "There were people concerned about his stability," says Kip Carter.

"It was a very, very bad period of my life," Newt has admitted. "It had been getting steadily worse. I ultimately wound up at a point where suicide, or going insane, or divorce were the last three options." In April 1980, he told Jackie, who was suffering from uterine cancer, that he was filing for divorce.

He was soon having an affair with a woman known to a member of his staff as "the mystery lady." Fifteen years younger than Newt's wife, she had "big cow eyes," says one former congressman. It was the future Marianne Gingrich, whom Newt had met at a Republican fund-raiser in Ohio in January of 1980.

Certainly no way to treat anyone who has been given a cancer diagnosis. I cannot understand how anyone could profess to be shocked about Newt's background unless they either suffer from a very very poor memory or they've just not bothered to learn anything about the man. Hopefully this latest flap will bring back up what Newt has really done, to remind the public who the guy actually is.

Newt, Family Values, and the Relationship Question

Newt Gingrich has been accused by his ex-wife Marianne of having asked for an open relationship. What he did get was a divorce. James Grimaldi writes today in the Washington Post that:

Presidential candidate Newt Gingrich in 1999 asked his second wife for an “open marriage” or a divorce at the same time he was giving speeches around the country on family and religious values, his former wife, Marianne, said Thursday.

In an interview with The Washington Post, Marianne Gingrich said her former husband called her on May 10, 1999, as she was having dinner with her 84-year-old mother and said, “I want a divorce.”

Newt of course denies that he asked for an open relationship:

At the Republican presidential debate Thursday night, Gingrich responded directly to his ex-wife’s allegations for the first time, issuing a blanket denial. “The story is false,” he said.

After Gingrich’s comments at the debate, Marianne Gingrich declined to direcly respond to the denial, other than to say she was sticking by her story, which she said is “the truth.”

Earlier in the day at a campaign event in South Carolina, the former speaker of the House had called the interviews with his former wife “tawdry and inappropriate” and refused to answer questions about them. “I’m not going to say anything about Marianne,” he said with his third wife, Callista, standing a few paces behind him.

Gingrich has said on several occasions that he has made mistakes in his life and has asked God for forgiveness.

I've been critical of Newt Gingrich ever since I got involved in politics back in the mid-1980s. Beyond his politics, with which I disagree wholeheartedly, he has an awful history regarding relationships, there's no doubt of that. There's more than a tinge of hypocrisy when Newt talks about "family values". Yet, this story doesn't quite ring true for me.

What if Marianne had agreed to being in an open relationship? Would Newt have actually gone through with it? People can forgive past mistakes, even sins - for some it's a religion, yet those are sins in the past, they're not ongoing. As hubristic as Newt is, even he would surely have realized that such a set-up would have inevitably become known, the resulting publicity destroying his conservative credentials and torpedoing his career. It's a great story, salacious and titillating, and it reminds everyone of what a schmuck Gingrich is, but I have my doubts about it.

Canadian Drug Policy - Support for Reform Grows In Spite of US Pressure

The US Office of National Drug Control Policy today released its first-ever National Northern Border Counternarcotics Strategy. According to Benjamin Tucker on ONDCP's official blog:

The Strategy outlines new actions that seek to reduce the two-way flow of illicit drugs between the United States and Canada by increasing coordination among Federal, state, local, and tribal enforcement authorities, enhancing intelligence-sharing among counterdrug agencies, and strengthening our Nation’s ongoing counterdrug partnerships and initiatives with the Government of Canada and Canadian law enforcement agencies. The Strategy places a special emphasis on improving cooperation with tribal governments, devoting an entire chapter to enhancing law enforcement coordination on tribal lands. By strengthening integrated cross-border law enforcement between our two countries, the Strategy supports a key area of cooperation outlined by President Obama and Prime Minister Harper in the Beyond the Border declaration.

The big question is, how badly will US officials strongarm the Canadian government into continuing to tow the drug war line? Canada's current Prime Minister and governing party notwithstanding, Canadians have been growing more and more supportive of drug policy reforms, as evidenced by a new poll. According to the National Post's blog on Jan. 17, 2012:

Released on Tuesday, the poll suggests 66% of Canadians are in favour of the legalization or decriminalization of marijuana, with just 20% supporting leaving the laws as they are now.

The poll, conducted by Toronto-based Forum Research Inc., showed that residents of British Columbia were the most likely to support marijuana laws reform, with 73% of respondents indicating laws should be changed. Quebec had the lowest support for reforms, though the majority of respondents, 61%, supported changing marijuana legislation.

Politicians in Canada are slowly catching up with the public. The National Post also noted that:

This public support comes on the heels of a new party policy approved at the Liberal Party of Canada’s renewal convention pushing for the legalization and regulation of marijuana. While it was the Liberals’ youth wing who initially put forward the motion, the poll shows it’s baby boomers who are the most likely to respond favourably to new marijuana legislation.

Getting Ahead of the Story

Earlier I blogged about a bit of sports diplomacy which the Russians had announced, that they were going to have an alcohol-free Olympic camp at the London 2012 games (This Bit of Sports Diplomacy is Smart Politics). Very smart, I thought, considering the bad reputation which Russia has in regard to alcohol (definitely check out the World Health Organization's 2011 "Global Status Report on Alcohol and Health," it's a very good read.)

Now the other shoe drops. Russian President Vladimir Putin has announced that he may allow beer sales at World Cup venues during the 2018 competition, according to AP (here's the link to the story on the ESPN site):

Russian Prime Minister Vladimir Putin says he'll reconsider the ban on beer at sports stadiums ahead of the 2018 World Cup.

Putin was questioned about the ban Thursday when he and FIFA president Sepp Blatter met with fans in St. Petersburg as part of commemorations of the 100th birthday of the Russian soccer federation.

As president, Putin signed a 2005 law banning beer and beer advertisements at sports venues.

Verificati​on of Colorado's Initiative 30 ("Use and Regulation of Marijuana) to require line-by-li​ne review

A random sample of signatures selected by the state for verification determined that backers that backers submitted valid signatures equivalient to 103% of the total needed to qualify for ballot status, however according to the elections office a validity rate of more than 110% is required for an initiative to automatically be placed on the ballot. Validity rate of between 90-110% for a sample means that a line-by-line review of signatures will be performed.

The Colorado Secretary of State's office issued the following news release today:

http://www.sos.state.co.us/pubs/newsRoom/pressReleases/2012/PR20120119Initiative30.html

STATE OF COLORADO
Department of State
1700 Broadway
Suite 250
Denver, CO 80290

Scott Gessler
Secretary of State

William A. Hobbs
Deputy Secretary of State

News Release

FOR IMMEDIATE RELEASE
January 19, 2012

MEDIA CONTACTS: Rich Coolidge
richard.coolidge@sos.state.co.us
Andrew Cole
andrew.cole@sos.state.co.us
(303) 860-6903

Verification of Initiative 30 to require line-by-line review

Denver, Colorado - Today Secretary of State Scott Gessler announced that the proposed ballot measure concerning “Use and Regulation of Marijuana” will require a line-by-line review of signatures.
Petitions for proposed initiative #30 were submitted to the Secretary of State’s office on January 4. The office immediately began verifying a random sample of the signatures as set forth in state statute. Section 1-40-116(4), C.R.S., requires the verification of each signature filed if the random sample shows the number of valid signatures falls between 90 percent and 110 percent of the signatures needed.

Random Sample Summary:
•Total number of qualified signatures submitted: 163,598
•5% of qualified signatures submitted (random sample): 8,180
•Total number of entries accepted (valid) from random sample: 4,436
•Total number of entries rejected (invalid) from random sample: 3,744
•Number of projected valid signatures from random sample: 88,719
•Total number of accepted entries necessary for placement on ballot: 86,105
•Percentage of presumed valid signatures: 103.04%

Because the 103 percent projection falls between the 90 and 110 percent described in statute, the Secretary of State’s office has notified the proponents the petition will require a line-by-line review. The office has until February 3 to complete the review.

For more information, visit our Initiative Information page.

# # #

This Bit of Sports Diplomacy is Smart Politics

Sports diplomacy is nothing new - the story of pingpong and the opening of US-China relations is famous (check out this excellent article from Smithsonian Mag). This year, the Russian Federation is using its Olympic sports team to score political points in an another way, simply to burnish its image internationally.

BBC News journalist Christine Jeavans reported Jan. 13, 2012 (BBC News: London 2012: Team Russia plans alcohol-free royal base) that

The Royal Household wants to rent out a field next to Kensington Palace Russia's public base for London 2012 will be a "family friendly" alcohol-free space on royal land, officials have announced.

The proposed site for Team Russia Park, which would be open to the public for the duration of the Olympic Games, is Perks Field, next to Kensington Palace.

The land is currently used for football matches, archery and school events and has a helicopter landing pad.

Russia plans to turn it into a space where people can support the team.

At a Russian Embassy launch on Thursday evening, officials said they aimed to create "a little piece of Russia in the heart of London," with folk music, traditional food and "true Russian hospitality" - but no vodka.

"If people want to drink they will have to go to the big screens in Hyde Park," said Edward Cowell of event management company Eventica.

The focus for the park, which will also have fashion shows, a sports area and screens for Olympic action, is a healthy participation in sport, he said.

Russian athletes past and present will offer masterclasses and families can enjoy a kids zone.

"We would like to increase the number of people who participate in sport and engage in a healthy lifestyle," said Akhmed Bilalov, Vice President of the Russian Olympic Committee.

For more here's the link: http://www.bbc.co.uk/news/uk-16543167

UNODC Issues Full Afghan Opium Report for 2011 - Afghan Opium Production, Profits Rise

The United Nations Office on Drugs and Crime issued its full Afghan Opium Survey for 2011 on Jan. 12, 2012. According to the UNODC press office:

The full Afghan Opium Survey for 2011 points to a dramatic increase of 133 per cent in the farm-gate value of opium compared with 2010 (the summary findings of the survey were issued in September 2011). Released today by the Ministry of Counter-Narcotics of Afghanistan and the United Nations Office on Drugs and Crime (UNODC), the survey reveals that the farm-gate income generated by opium probably amounted to $1.4 billion, equivalent to 9 per cent of the GDP of Afghanistan in 2011.

Even more striking is the potential income derived from opium production. Export earnings from Afghan opiates may be worth $2.4 billion – equivalent to 15 per cent of GDP. Such vast sums cannot easily be earned in other ways. “Opium is therefore a significant part of the Afghan economy and provides considerable funding to the insurgency and fuels corruption,” said Yury Fedotov, Executive Director of UNODC.

Almost 60 per cent of farmers surveyed in 2011 said that they were motivated primarily by the high prices fetched by opium poppy cultivation, which will continue to remain attractive if it reaps bumper profits, according to the survey. Compounding the problem was a simultaneous drop in the price of wheat. In 2011, the gross income from opium was 11 times higher than that from wheat, the biggest difference in income since 2003.

In 2010, plant diseases wiped out much of the opium yield and the resulting scarcity of fresh opium triggered a speculative rise in prices. While higher prices had been expected in 2011 after opium yields returned to pre-blight levels, the 2011 values far exceeded expectations. The gross per-hectare income from opium cultivation ($10,700) also reached levels not observed since 2003.

Around 90 per cent of the world’s opium comes from Afghanistan. The survey showed that the area of land used for opium poppy cultivation in 2011 was 131,000 hectares, 7 per cent higher than in 2010. The amount of opium produced increased by 61 per cent, from 3,600 metric tons in 2010 to 5,800 metric tons in 2011.

The report is available from here.

Gov. Gary Johnson Interviewed by Joe Schrank of The Fix

This November 2011 article and video interview with presidential candidate and former New Mexico Governor Gary Johnson is from The Fix, "a daily website about alcoholism, addiction, recovery and the drug war." It is well worth checking out. Here are the closing paragraphs:

Johnson's willingness to break step with the vast majority of US politicians on prohibition is brave, although a trailblazer is often doomed to forge a path that others later follow with more success. His views on marijuana aren't at odds with US voters. But the powerful TV networks and party establishment are proving slower to follow public opinion, which leaves him starved of publicity.

And that's a shame. Without the full participation of a dissenting voice like Johnson's, drug and addiction issues are set to receive little airtime in the 2012 presidential campaign. The Fix has asked several other candidates for an interview or statement on their drug policy and received no response—except from a spokeswoman from the Michele Bachmann campaign, who simply replied, "What drug policy?" Whatever your views on prohibition, this lack of political scrutiny of a vital policy area—directly affecting many millions of Americans and others around the world, and perceived by many to be failing—is anything but healthy.

http://www.thefix.com/content/video-gop-candidate-gary-johnson-visits-fix9245