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More Teens Try Pot before Booze, Cigarettes 

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More Teens Try Pot before Booze, Cigarettes 

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Current Event 15

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Understanding OTC (Over-The-Counter) Drugs

Over-the-counter (OTC) drugs are medications available without a prescription at drugstores or supermarkets.

OTC drugs are typically safe if used at recommended doses. Like illegal and prescription drugs, they can also be abused. Although less potent than other substances, OTC drugs still pose a risk for developing an addiction.

Abusing OTC drugs can lead to health problems including memory loss, kidney failure, heart problems and death.

Some commonly abused OTC medications include:

Cough medicines (Dextromethorphan, or DXM)

Cold medicines (Pseudoephedrine)

Motion sickness pills (Dimenhydrinate)

If you or someone you love is struggling with an OTC drug addiction, call a treatment provider for rehab-related help.

OTC Drug Abuse

OTC drugs have various medical uses and effects, treating mild pain to motion sickness. Some abuse OTC drugs to self-medicate for mental illnesses like anxiety and depression. Abusing these medications can also give users a euphoric "high" or hallucinations. Any use outside of what's recommended is considered abuse.

Someone abusing OTC drugs might move on to more dangerous or illicit drugs in search of a better high.

Cough Medicines (Dextromethorphan, or DXM)

Cough medicines can cause hallucinations and a potent high when abused. Cough medicines are popular among young people, as they're often readily accessible in medicine cabinets at home or at a friend's house. The Drug Enforcement Administration (DEA) lists different dose-dependent plateaus, as experienced by people who abuse DXM. The maximum recommended daily dose of DXM is 120 mg; beyond that, intoxication and dangerous side effects begin to appear.

A dose of 100-200 mg induces mild stimulation and euphoria.

A dose of 200-400 mg leads to stronger euphoria and hallucinations.

A dose of 300-600 mg causes loss of motor coordination and visual distortions.

A dose of 500-1500 mg leads to out-of-body sensations.

High doses of DXM can cause

Breathing problems

Blacking out

Muscle twitching

Extreme drowsiness

Heart palpitations

Changes in blood pressure

Elevated body temperature

Vomiting

Rapid heart rate

Blurred vision

Muscle twitching

Brain damage

Break free from addiction.

You have options. Talk about them with a treatment provider today.

(888) 461-0037

Cold Medicines (Pseudoephedrine)

Pseudoephedrine is a stimulant and the active ingredient in many cold medicines. It is used to relieve nasal and sinus congestion from colds or allergies and may also relieve congestion. In rare cases, may abuse pseudoephedrine for hallucinations or an intense "body high."

Pseudoephedrine is also used to create illicit drugs like methamphetamine. Abusing pseudoephedrine can cause irregular heartbeat, shortness of breath, high blood pressure, dizziness and seizures.

Motion Sickness Pills (Dimenhydrinate)

Dimenhydrinate is used to treat motion sickness and vertigo. In high doses, the drug can cause hallucinations, ringing in the ears, nausea, irregular heartbeat, seizures, coma and even death. The drug is often abused for its psychedelic properties. The drug is considered a deliriant when taken in high doses (between 200-1200 mg depending on body weight).

Looking for a place to start?

Reach out to a treatment provider for free today.

- OR -

OTC Drug Addiction

Recreational OTC drug use can also change the brain's chemistry over time. Eventually the user builds a tolerance to the drugs, needing more of the substance to get the previous effects. Those addicted to OTC drugs maybe also develop withdrawal symptoms when they stop using.

Common symptoms of OTC drug withdrawal include:

Learning to spot an OTC drug addiction can be difficult. OTC drugs like Tylenol and various cough medicines don't carry the same dangerous image as illicit drugs like Heroin. People don't always see them as addictive, so many loved ones of people addicted to OTC drugs don't know to look for signs of a growing problem.

Some of the signs of an OTC drug addiction include continuing to use the drugs despite known consequences and spending an excessive amount of time or money using or getting them. There are 11 key criteria to diagnose an addiction to any drug.

OTC Drug Abuse Statistics

OTC Drug Addiction Treatment

Those suffering from OTC drug addiction have many treatment options. Individual and group therapies, mental health counseling, and psychotherapies like Cognitive Behavioral Therapy (CBT) are all effective treatment methods.

Inpatient and outpatient rehab programs allow those recovering from OTC drug addiction the resources to get and stay sober. Enrolling in a drug rehab program can significantly reduce the odds of relapse.

Get The Resources To Beat Addiction

Overcoming an OTC drug addiction can be difficult, but it is far from impossible. Inpatient drug treatment programs give recovering addicts 24-hour medical care, while those in outpatient programs can visit specified medical centers while keeping their home lives intact. Attending a 12-step group like Narcotics Anonymous can provide community and support to help with lasting recovery. If you or someone you care about is struggling with an addiction to OTC drugs like Dextromethorphan, contact a treatment provider to discuss available treatment options.

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Over-The-Counter (OTC) Drug Addiction, Abuse, And Treatment

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Over-the-counter (OTC) drugs are medications available without a prescription at drugstores or supermarkets. OTC drugs are typically safe if used at recommended doses. Like illegal and prescription drugs, they can also be abused. Although less potent than other substances, OTC drugs still pose a risk for developing an addiction.

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The high cost of prescription drugs is on everyone's agenda. In more than 40 states, pharma-related bills are pending or recently passed. President Trump, Health and Human Services Secretary Alex Azar, Food and Drug Administration Commissioner Scott Gottlieb and the Centers for Medicare and Medicaid Services have advanced proposals to bring down prices. Congress passed an anti-gag clause bill, letting pharmacists give more information to patients to help them save on costs.

It is no surprise that public officials, hearing the drumbeat of complaints from the public, are scrambling to get a handle on the problem. Drug prices have risen at an alarming rate in recent years, outpacing all other aspects of health-care spending, including nursing home costs.

Specialty drugs lead the way with eye-popping price tags - current therapies for hemophilia are priced at $580,000 to $800,000 a year; Novartis plans a $475,000 price tag for its Car-T drug Kymriah, which treats non-Hodgkin's lymphoma.

But it is not just prices for new drugs and rare conditions that are causing so much pain. Pharmaceutical companies have raised prices most sharply for commonly used medications to treat diabetes, high cholesterol and asthma.

How did we get here? The answer can be found in this country's shadowy and byzantine system for negotiating drug prices and rebate deals. The system contains odd and perverse incentives, with the result that higher- priced drugs can receive more favorable health-plan coverage, channeling patients toward more expensive drugs.

At the heart of the system lies the industry known as pharmacy benefit managers (PBMs). Historically, PBMs operated mostly as claims processors. Although the industry experienced significant shifts in the 1990s when claims processing moved to the digital world, the real transformation took place in 2006. In that year, prescription drug coverage became part of Medicare, introducing a massive influx of patients with prescription drug coverage into the market. PBMs took on an additional role for a wide range of health plans: helping plans set formularies (the terms on which patients can access drugs) and negotiating prices with drug companies. The rise in prices that followed has been dramatic. Between 2006 and 2014, prices for drugs rose by an average of 57 percent, and prices for drugs with no generic substitutes rose by 142 percent.

What caused the increases?

Here is how our current system works. It starts with a structure that looks healthy on the surface. Health plans pay their PBMs based on the extent of the discount that a PBM can negotiate with individual drug companies. In theory, this should encourage the PBM to drive prices down. After all, entities should bargain hard when their pay is tied to how much of a discount they can negotiate.

The problem? Drug companies raised their prices so they could give a greater discount. This increases how much of a "discount" the PBM can claim to have negotiated, and the payout to the PBM. It is a little like a department store raising prices right before a sale so the sale discount looks more appealing.

All of this might not be so bad if no one paid the high list price. But many people do. Many plans make patients pay full drug costs until they meet their deductible, and other plans require coinsurance - both of which are based on the list price. Many people still do not have coverage for prescription drugs, even if they have health insurance. Thus, people are forced to pay the full price at various times. Worse yet, the entire structure encourages drug companies to compete not by cutting prices but by offering higher prices.

Pharmaceutical companies offer the same types of rebate deals to hospitals, to clinics that administer medication and to doctors who deliver medication such as injections or infusions in their offices. The hospital or other facility charges the patient a higher list price and then receives a rebate later from the drug company, ultimately pocketing the difference. And they also provide other types of payments under labels like "administrative fees" and "data fees." If policymakers try to reduce or eliminate rebates, drug companies can still provide payments to everyone in the distribution chain by shifting that flow of money to other types of fees.

The name of the game is volume. The more volume a drug company has with a particular PBM or hospital, the better deal it can offer as a temptation to exclude rival drugs. It is a little like Budweiser going to a bar owner with the following offer: "Okay, at the end of the year, I'll pay you 50 cents a bottle if you've sold 40,000 bottles of Bud. Better yet, I'll make it $1 a bottle if you don't put any of that microbrewery's beer on the menu." If the microbrewery starts out by selling a limited number of bottles, how could it ever compete? The little guy could never offer enough off the price on its few beers to compensate for the tens of thousands of dollars the bar owner would forgo by rejecting Budweiser's offer.

These rebate spreads and other fees are clearly incentives to prescribe the drug. In exchange for lucrative payments, a drug company can ensure that more expensive drugs receive a more favorable reimbursement position and less expensive drugs are shut out. This narrows prescription choices and undermines competition from generic drugs and from other drugs within the same class of medications that might provide excellent results at a lower price.

In 2013, when the Supreme Court handed down a decision that cast doubt on the drug companies' practice of paying generic competitors to stay off the market, drug companies doubled down on other strategies designed to hobble generics, including these rebate schemes.

Government also plays a role. Many of these drugs are protected by strong patents and other exclusivity rights that give the company a monopoly over the market. Drug companies apply for these benefits in a variety of ways, including by performing pediatric testing, pursuing other new clinical studies, developing so-called orphan drugs and creating drugs for tropical diseases. Companies can manipulate this rights system to their advantage during negotiations with hospitals, doctors and health plans. For example, a government-protected monopoly can be used to arrange protection for other drugs that are facing competition.

Recent real-world examples of this cycle of market manipulation abound. For example, in October 2017, Shire sued Allergan alleging that Allergan used bundled rebates to preserve the dominant market share of its blockbuster dry-eye medication, Restasis. In addition to the company's monopoly position in the dry-eye medication market, the company controlled the market for glaucoma drugs, for which no generic drugs were available.

When the FDA approved a new drug in the dry-eye market, the company offered a plan in which attractive deals in the glaucoma market would be available for those who also gave favorable treatment to the company's dry-eye medication. According to one Medicare plan administrator quoted in the complaint, given Allergan's bundling scheme, a competitor could give the new drug away free and the numbers still wouldn't work.

What does all of this mean? Patents and exclusivities are intended to incentivize innovation in the drug industry, providing a time-limited monopoly to recoup costs followed by vigorous competition to bring the price down to competitive levels. Instead, drug companies are manipulating the system, often recycling and repurposing drugs rather than inventing new ones. In fact, 78 percent of the drugs associated with new patents were not new drugs coming on the market but existing ones. The cycle of innovation, reward, then competition is being distorted into a system of innovation, reward, then more reward.

At the end of the day, drug companies are able to use financial incentives to ensure that as lower-priced alternatives enter the market, they cannot gain much of a foothold. The companies have simply found a way to operate within the system to their own greatest advantage. Can one really expect anything different from profit-making enterprises?

Unfortunately, it is lose-lose for the rest of us. Manufacturers raise the price, and at least some patients pay the higher price. With those who don't, the money created by the rebate spreads to the middle players - PBMs, hospitals and doctors - who then extend competition-free zones for the drug company's drug. In the short term, society pays more in the form of higher prices; in the long term, society pays more in the form of fewer competitors to offer lower-priced drugs. Today and tomorrow, society pays and pays again.

The pharmaceutical industry has introduced extraordinary health-care advances. One cannot overemphasize the major life improvements over the past century that flow from innovation in prescription medications, including new lifesaving antibiotics, treatments for pain, psychopharmacological treatments and cancer drugs. As one physician pointed out to me, former president Jimmy Carter has already lived several years beyond his diagnosis of metastatic cancer, thanks to a drug that did not exist a decade ago. However, if we don't get a handle on the perverse incentives operating throughout the system, we may be pricing ourselves and our economy into oblivion.

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Perspective | Why prescription drug prices have skyrocketed

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The high cost of prescription drugs is on everyone's agenda. In more than 40 states, pharma-related bills are pending or recently passed. President Trump, Health and Human Services Secretary Alex Azar, Food and Drug Administration Commissioner Scott Gottlieb and the Centers for Medicare and Medicaid Services have advanced proposals to bring down prices.

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Current Event 15

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The drug MDMA makes people more cooperative toward those they trust, according to new research. The finding offers new insights into how MDMA could aid the treatment of post-traumatic stress disorder.

MDMA or ecstasy pills may have an unexpected effect on your brain, a new study suggests.

Commonly known as ecstasy or Molly, MDMA is a synthetic compound that alters perception and mood by changing brain chemistry.

The recent study by King's College London in the United Kingdom also identifies alterations in brain activity that accompany MDMA's impact on cooperative behavior.
The changes occur in regions of the brain that scientists have linked to social interaction and processing.
The researchers, including senior study author Mitul Mehta, a professor in the Institute of Psychiatry, Psychology, and Neuroscience at King's College London, detail their work in a paper that features in the Journal of Neuroscience.

Phase 3 clinical trials are presently testing MDMA as a treatment to accompany psychotherapy for post-traumatic stress disorder (PTSD).

The King's College London study is the first detailed investigation into how MDMA alters cooperative behavior.

"Given the social nature of psychotherapy," says Prof. Mehta, "understanding how MDMA affects social interaction sheds light on why the drug could become a valuable tool in treating patients."

MDMA alters brain chemistry

Current medications do not work in a number of psychiatric conditions that feature difficulty with processing social information.

In this context, regulators in the United States have given MDMA "breakthrough therapy status," effectively putting it on a faster than normal track for development and review.
MDMA alters brain chemistry by increasing the activity of several messenger molecules, including serotonin.
Altered serotonin activity affects not only mood but a range of other functions, such as sleep, appetite, trust, and sexual arousal.

The increased empathy and intimacy that people feel when under the influence of MDMA likely comes from the release of large quantities of serotonin.

Impact on social processing unclear

However, the complexities of how MDMA affects social behavior and processing of social information is not well understood.

To investigate this further, Prof. Mehta and his team recruited 20 adult men in good health and with no history of psychiatric or other neurological illness to take part in their research.
The men took either a typical recreational dose of MDMA or a placebo and then completed a number of tasks.
While they undertook the tasks, a magnetic resonance imaging ( MRI) scanner recorded "functional images" of their brains.

One of the tasks that they had to complete was a game of cooperation and trust known as the Prisoner's Dilemma. This game formed the heart of the study.

A game of dilemmas

The game has two players pitched against each other and awards points, depending on which of two decisions each player makes. A player does not know the decision their opponent has made until after both have made their play.

The version of the Prisoner's Dilemma that the participants played involved several rounds. At each round, the players decided whether to cooperate or compete.

If both players chose to cooperate, both won 90 points. If both chose to compete, both won 60 points. When one chose to cooperate and the other chose to compete, the first won only 30 points while the second won 120.
Thus, cooperation is clearly a strategy that avoids low scores, as long as your opponent also cooperates. But do you trust them? Each game has 15 rounds, so there is an opportunity to learn whether to trust or not and decide which strategy to adopt.
The men taking part in the study believed that they were playing against real people. However, their opponents were three different computer programs with pre-set response patterns that differed by the amount of cooperation as the game progressed.

After each round in a game, the players scored their level of trust in their opponent.

MDMA may not affect gullibility

The results showed that cooperation increased as games progressed for those players who took MDMA. However, this only happened when they rated their opponent as trustworthy.

Prof. Mehta says that the researchers were surprised that MDMA did not change the men's opinions of their opponents' trustworthiness.

"Untrustworthy players were rated as low on the scale, whether on MDMA or placebo, and trustworthy players were given equally high ratings," he adds.

The result is significant because it suggests that while MDMA may increase trust, it does not make people more gullible.

From the MRI scans, the team could see that MDMA altered brain activity while the individuals processed the behavior of their opponents, without affecting their decision making.

The scans showed that MDMA increased activity in brain regions linked to understanding the thoughts, intentions, and beliefs of others.

There were also other parts of the brain where the effect of MDMA was different, depending on whether an opponent was trustworthy or not. One of these areas helps to integrate evaluation, uncertainty, and risk.

"Understanding the brain activity underlying social behaviour could help identify what goes wrong in psychiatric conditions."

Prof. Mitul A. Mehta

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Study investigates how MDMA affects cooperation and trust

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The drug MDMA makes people more cooperative toward those they trust, according to new research. The finding offers new insights into how MDMA could aid the treatment of post-traumatic stress disorder. MDMA or ecstasy pills may have an unexpected effect on your brain, a new study suggests.

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current event 14

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A new review offers further insight into how long-term marijuana use might have a negative impact on mental health, after finding "substantial evidence" that the drug alters the brain's reward system to increase negative emotions and decrease motivation.

Researchers say long-term marijuana use lowers dopamine levels in the brain, which could explain why some users develop mental illness.

The study says there is sufficient evidence to suggest marijuana, or cannabis, reduces levels of dopamine in the brain - a neurotransmitter that plays a key role in learning, movement, motivation, emotion, and reward.

Low dopamine levels have been associated with mood changes, fatigue, depression, and lack of motivation; dopamine deficiency is present in a number of neurological conditions, including Parkinson's disease and attention deficit hyperactivity disorder ( ADHD).

Study leader Prof. Oliver Howes, of the Medical Research Council (MRC) Clinical Sciences Center at Imperial College London in the United Kingdom, and team recently published their results in the journal Nature.

According to the 2014 National Survey on Drug Use and Health, there are around 22.2 million marijuana users in the United States, making it the most commonly used illicit drug in the country.

Long-term marijuana use has been linked to a number of mental health conditions, including schizophrenia, anxiety, and depression, but the mechanisms underlying this association have been unclear.

Given the increased legalization of marijuana for medicinal and recreational purposes, researchers are keen to learn more about how the drug affects the brain.

For this latest study, Prof. Howes and team conducted a review of numerous studies investigating how the primary psychoactive compound in marijuana - tetrahydrocannabinol (THC) - affects the brain.

THC exposure has long-term effects on the dopamine system

According to the researchers, there is now "substantial evidence" in animal and human studies that long-term exposure to THC leads to a decrease in levels of dopamine.

"The available evidence indicates that THC exposure produces complex, diverse and potentially long-term effects on the dopamine system," the authors explain. "These include increased nerve firing and dopamine release in response to acute THC, and dopaminergic blunting associated with long-term use."

The team believes this effect may explain why people who engage in long-term marijuana use are at increased risk for mental health problems.

In animal models, current research shows that marijuana use initially raises dopamine levels, fueling a sense of reward, which the team says may offer an explanation for why some users become addicted to the drug.

However, the authors point to some limitations in this area. "Fundamentally, animal studies are too short, and don't give cannabis repeatedly or in combination with other substances," notes Prof. Howes.

Addressing the gaps in marijuana research

The researchers also noticed some other gaps in research, such as studies assessing what happens to the dopamine system when marijuana use is ceased.

What is more, the team notes it is important to learn more about how marijuana use affects brain development, as some women may use the drug in early pregnancy, before realizing they are expecting.

"Given the increasing use of cannabis, particularly in young people and women who may be pregnant, animal studies are needed to understand the effects of long-term cannabis use on the developing brain in a controlled way that is not possible in human studies." says Prof. Howes.

"These studies also need to use techniques that can be translated into human studies, and to better represent human patterns of use."

While further investigation into the effects of marijuana is clearly warranted, the researchers believe their current study helps broaden our understanding.

"The changing patterns of cannabis use, including 'cannavaping' and edible products, mean it's vital that we understand the long-term effects of cannabis on the brain.

This new research helps to explain how some people get addicted to cannabis, by showing that one of its main components, called THC, alters a delicate balance of brain chemicals."

Co-author Dr. Michael Bloomfield, Clinical Sciences Centre, Imperial College London

Read about a study that sheds light on how marijuana causes memory loss.

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Marijuana and mental illness: Low dopamine levels may play a role

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A new review offers further insight into how long-term marijuana use might have a negative impact on mental health, after finding "substantial evidence" that the drug alters the brain's reward system to increase negative emotions and decrease motivation. Researchers say long-term marijuana use lowers dopamine levels in the brain, which could explain why some users develop mental illness.

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Current Event 14

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Let's fantasize of an across-the-board legalization of marijuana by the federal government. Stop laughing and set aside all of the improbabilities of such fantasia for now. Our purpose is to examine the ramifications of legalizing a substance that, in the past century, has infected our federal masters with an arguably unprecedented messianic zeal and unslakeable thirst for moralistic discipline. That such a rollback of federal marijuana statutes could ever occur amidst the current climate of rampant general paranoia and loathing of all things even slightly subversive is, indeed, laughable. But we soldier on. In fact, it is in the spirit of living during a time of most oppressive fear and loathing where we may begin. Assume all is the same, except we are now free to cultivate and smoke pot with impunity. Let's see how this might play out.

We've already made our first incorrect assumption. Cultivate with impunity? Not likely. First we must procure our Official United States Marijuana Grower's license from the newly created Office of Psychoactive Substances, a subdivision of the Department of Agriculture. We can't just walk in and get a license, of course. First we must navigate a Kafkaesque labyrinth of regulatory obstacles, beginning with the license application itself, form THC-420. So dense with irrelevant minutiae is this voluminous questionnaire, inquiring deeply into our motivations for becoming a federally sanctioned cannabis farmer, we may well decide to just grow our buds on the sly. Ah, but woe betide to any who deign to "moonshine"--grow sans license. So declares the sign on the wall at the OPS office:

"Any individual and/or organization who shall grow or attempt to grow unlicensed cannabinoidal substances shall be subject to a fine of not less than one-thousand dollars ($1,000.00) per metric ounce of cannabinoidal substance and shall also be subject to a term of no more than six (6) months in a federal penal institution, or, should said weight not exceed one metric ounce, said fine shall not exceed nine-hundred-ninety-nine dollars ($999.00) and said penal liability shall not exceed one-hundred-seventy-nine (179) consecutive days. Furthermore, any individual and/or organization who shall abet or attempt to abet another in the cultivation of unlicensed cannabinoidal substances shall be subject to the same penalties as described above, pursuant to United States Federal Penal Code BS--MF--13."

Yikes! So we slog through the form--"pressing hard", as it warns balefully, for we are making five (5) copies! Finally, our hand throbbing from writer's cramp, we proudly present our application to the gum-snapping, perfunctorily friendly drone, so bureaucratically ensconced behind her unnecessarily high counter. We shift restlessly as our government servant peruses our form with what seems like resigned boredom disguised as rigid contempt. At last, she produces a rather large rubber stamp and similarly proportioned inkpad. With deliberate deliberation she stamps the front page of our form: "Approved, subject to applicant's case history, digital processing, and payment of processing fee". Case history? Digital processing? Processing fee? The clerk sighs, and with the manufactured patience of one speaking to an errant child, explains that our application will be approved, provided we pass an extensive background check, submit to fingerprinting, and fork over five-hundred dollars ($500.00) for the privilege. Undeterred, we dutifully recite our social security numbers aloud--she has apparently forgotten she could just as easily have copied them from the front page of our form THC-420, which still resides on the counter before her. She summons us behind the counter (!) to submit our fingerprints and pay our processing fee. We have spent five (5) hours at the OPS office.

Marveling at the rapidity with which the government constructed such an intimidating bureaucratic hash, we return home anxiously to await the arrival of our license. Six (6) weeks later, we receive a letter:

Dear Prospective Cannabis Grower,

Thank you for your recent application for licensing under the Realigned Cannabis Cultivation Act of two-thousand-four (2004).

We are sure you are anxious to receive your license and begin cultivating cannabis for the enjoyment of your family and friends. We share your excitement.

You will soon receive your Official United States Marijuana Grower's license in the mail. Please follow the instructions in the accompanying letter carefully.

Shortly after receiving your license, an Office of Psychoactive Substances Inspector will come to your residence. DO NOT commence cultivation until the inspector has cleared your facilities for cultivation. The inspector will advise you of all pertinent growing regulations for your area.

Once again, thank you for your application. We look forward to doing business with you.

Sincerely,
John Walters
Second Assistant Deputy Undersecretary for Cannabinoidal Cultivation
Office of Psychoactive Substances
Department of Agriculture
Washington DC

Six (6) weeks after this letter, we receive our license. Approximately five (5) minutes after we open the envelope, there is an aggressive knock at the door. It's the inspector, of course. Clad in a dark blue windbreaker with "OPS" printed large across the back, he invites himself in. If we didn't know any better, we'd have pegged this guy as Narco. Of course, now we glimpse a faded DEA t-shirt through his carefully unzipped jacket! It is open far enough to see his shoulder-holstered Desert Eagle as well. He scans the room from behind opaque aviator sunglasses and flips open his credentials and badge:

OPS guy: Agent Smith, OPS.

Us: Where do you want to start?

Smith: Will you be growing indoors or out?

Us: Hydroponics. In that room over there.

Smith: Can't do that. It's a street exposed room. Kids might see in.

Us: Uh, okay. I guess we'll do it in the back bedroom.

Smith: (now in back bedroom) Ok, this will be fine. Just keep the windows covered.

Us: Yes, sir.

Smith: What are you going to grow?

Us: Marijuana.

Smith: (visibly annoyed) What strain?

Us: Oh. Thinking about Super Afghani.

Smith: Can't do that.

Us: (sighing) Why not?

Smith: Aside from trafficking in seeds from a nation with which we are at war?

Us: Ah, of course. Tell you what, why don't you tell me what we can grow?

Smith: Glad to. (produces a thick tome from behind the Desert Eagle) All in there.

Us: Ok. Thanks.

Smith: I'll be back in six (6) weeks.

Us: Can't wait.

The manual weighs in at five-hundred-six (506) pages, not counting indices, appendices and addenda. From amidst the bureaucratic blah blah, we deduce three (3) main points: Firstly, power usage will be monitored. Excessive kilowatt-hours are grounds for a reclassification of our grow to "industrial reapage". In other words, we are producing too much for the reasonable use of a dozen (12) people. Our grow would then be considered as one of mass production, thus quintupling (5x) our taxes and "reapage fees". Secondly, we are required to submit names, ages and addresses of all who will partake in our harvest. Each member of our list must undergo "case history, digital processing and processing fee", just as we did three (3) months ago upon submittal of our grow application. The processing fee is a mere one-hundred dollars ($100.00) for smokers, however. Finally, our choices of strains we are allowed to grow are limited to "locally indigenous varieties only". If we wish to grow "non-indigenous" varieties we must complete form THC-420a/e\069, and submit an environmental impact statement along with any associated "impact fees". As we are not aware of any varieties "indigenous" to our northerly-located state, we resign ourselves to a failed attempt at legal cannabis cultivation. We pop a legally scripted Oxycontin to hold off a nascent migraine and set out for Eddie the Head's house, where we can partake "off-list" for a one (1)-time fee of fifty dollars ($50.00). Eddie has friends at the OPS; he scored a waiver.

published at Endervidualism on 6/11/04
Matthew Bryan resides in Nevada with his wife and pets. He pens libertarian screeds in his spare time to relieve his unrelenting fury toward the ever-encroaching state and those who abide and abet it. His columns have previously appeared onStrike the Root.

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So You Want To Be A Marijuana Farmer - by Matthew Bryan

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Let's fantasize of an across-the-board legalization of marijuana by the federal government. Stop laughing and set aside all of the improbabilities of such fantasia for now. Our purpose is to examine the ramifications of legalizing a substance that, in the past century, has infected our federal masters with an arguably unprecedented messianic zeal and unslakeable thirst for moralistic discipline.

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Why a City at the Center of the Opioid Crisis Gave Up a Tool to Fight It (Published 2018)

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Providing unused needles to people who inject drugs is an idea that has struggled to gain acceptance, in West Virginia and throughout the U.S.

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Desomorphine has been in the news a lot lately. Never heard of it? That's quite possible. But you may well have heard its street name: "Krokodil". However you know it, it's a cheap substitute for heroin that has been widely branded as a "flesh-eating zombie drug" - and it's bad news.

There are two reasons for its horrific reputation, one related to desomorphine itself, and the second, to the way the street drug is produced.

Desomorphine was actually first synthesised in 1932. As you would guess from its name, it is a "semi-synthetic" relative of morphine, the natural painkiller derived from opium poppies. Compared with morphine, it has one less double bond and one fewer -OH group (morphine has two, desomorphine has one). That's significant because the more -OH groups a molecule has, the better it will dissolve in water. Conversely, the fewer -OH groups a molecule has, the more lipid (fat) soluble it will be - and that makes it more likely to cross the blood-brain barrier.

In keeping with this, desomorphine is roughly 10 times stronger a painkiller than morphine and its effects are felt sooner. It is also eliminated from the body more quickly. Consequently, while a heroin user's euphoria may last four hours or more, a "Krokodil" "high" lasts for two hours at most. This means that more doses are required to sustain the high and that desomorphine has a greater potential to cause addiction, which can manifest within just days.

Indeed, desomorphine was originally synthesised to create a painkiller with fewer side effects than morphine. But while it did offer greater analgesic power, it fell into disuse because of its particular tendency to cause dependence.
The return of Krokodil
Desomorphine was largely forgotten for years - until circumstances conspired to bring it back into prominence. When the Russian government restricted the movement of heroin from Afghanistan into Russia in 2003, there was a sharp increase in the price of heroin on the street. As a consequence, Russian addicts started looking for cheaper substitutes, including desomorphine.

But we are not talking pharmaceutical-grade desomorphine, but rather a version made in kitchen laboratories. The base ingredient for this version is codeine, another natural painkiller found in poppies, with a structure not too different from morphine. Codeine is readily available - often over the counter - as a milder version of a painkiller than morphine. This is then mixed with a number of other additives to create "Krokodil".

So how did the name "Krokodil" come about? One theory is that it refers to the scaly green skin it can create around injection sites. Another is that it is a corruption of the name of one of the intermediates in its synthesis, "α-chlorocodide", which is formed when the codeine reacts with the additive, thionyl chloride. Maybe it is a bit of both.

Either way, while "Krokodil" use first became prevalent in Russia, leading to a lethal epidemic there, it has now spread to Colombia, the US, and Europe, including the UK.
Devastating consequences
Desomorphine is so cheap, partly because of the availability of codeine but also because making it is relatively straightforward; people attempt it at home without the use of a fully-equipped laboratory.

I won't describe the process in detail for obvious reasons. Typically, however, the codeine is prepared with readily obtained chemicals, including paint thinner, hydrochloric acid, iodine (from "tincture of iodine" antiseptics) and phosphorus (obtained from matchboxes). The process has a lot in common with the so-called "Nagai" method for making methamphetamine. Addicts often do this in their own kitchens and typically don't bother to purify the resulting substance, which creates more problems.

Users inject their impure desomorphine - and if they miss the vein, may end up with an abscess and dead flesh. Other health effects include gangrene, phlebitis, bone infection and pneumonia, not to mention brain damage. Needle sharing may be responsible for spreading HIV and hepatitis C. Tragically, addicts often die within two to three years.

Another reason "Krokodil" can be so destructive is the relatively short period of time the drug spends in the body. In order to prevent the onset of withdrawal symptoms, addicts can end up stuck in a continuous cycle of making and injecting, forsaking food and pretty much everything else in the process.

"Krokodil" has become a popular drug of abuse because it is cheap and easy to make. Sadly, the downside is much greater, leading to addiction, serious medical complications and death. Just don't go there.
Simon Cotton is a senior lecturer in chemistry at the University of Birmingham. This article first appeared on The Conversation (theconversation.com)

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How a flesh-eating drug containing paint thinner and phosphorous is causing a global crisis

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Desomorphine has been in the news a lot lately. Never heard of it? That's quite possible. But you may well have heard its street name: "Krokodil". However you know it, it's a cheap substitute for heroin that has been widely branded as a "flesh-eating zombie drug" - and it's bad news.

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Current Event 13

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Answers to parent questions about medical marijuana for epilepsy -- like does Children's Colorado prescribe it, is it an effective treatment, and more.

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Jamie Casey, right, speaks with Brian Peets at a homeless camp in New Bedford, Mass., on Aug. 10, 2018. "For 20 years I fought and fought and fought against myself. Because you're your biggest enemy. You know that, right?" Casey told Peets.

By MICHAEL HILL, Associated Press

Sidewalk prayers near shoot-up spots. Sunday sermons in the back of a bar. Pleas to struggling souls to surrender to God. Funerals for members of their flock who didn't make it.

Clergy members have become spiritual first responders in the opioid crisis, often leaving the pulpit to minister on the streets.

They can be reverends, rabbis, priests or pastors. Though their faiths differ, they invariably approach people with addiction as equals. No Bible-thumping, no blaming. Quite a few are in recovery themselves.

Despite some signs of a slowdown, the nation's all-time deadliest drug overdose epidemic endures. Opioids were involved in most of the deaths, killing nearly 48,000 people last year.

A spiritual element to recovery is familiar to people who have worked 12-step programs, with their references to an undefined higher power. Scientific studies have found evidence that religious faith can help substance abusers with their recovery.

Working with addicted people means trips to hospital rooms and fresh graves. But there are flashes of light in the darkness, too.

Three dispatches from the front lines:
A Church for Imperfect People
Nine minutes into his sermon, Pastor Brad Hill made a confession.

"I gotta be honest. I ask myself a lot of the times, 'God, why did you allow me to be an addict?" Hill says from the pulpit of his Grace Downtown Church. "Why are my friends dying of an overdose? ... I gotta ask God, 'Why, God, do you allow this?'"

Hill hears those questions a lot.

The church Hill started in the back of a Winchester, Virginia, bar moved this year to a space that can accommodate hundreds, many trying to turn the page on their addictions. Six and a half years in recovery, Hill calls it a totally judgment-free zone, "a church for imperfect people."

Hill has a salty beard, smiling eyes and booming voice to sermonize about the suffering he sees so often in the Shenandoah Valley. His phone lights up constantly with messages from struggling people and their loved ones. One recent text read: "Do those who commit suicide still go to heaven?"

Too often, Hill speaks at funerals for overdose victims, three in the past three months alone. He honors the dead while telling survivors, "You don't have to be like this person. There is a way out."

A funeral in September for a 38-year-old married father of four was especially hard on Hill. They were friends, and Hill had been talking to him about his struggle just a week before he died. It was Hill who welcomed the man's grieving family to a Sunday service.

"They lost one of ..." Hill swallowed, clapped his hands together twice, and continued in a softer voice. "They lost one of my favorite people. So I just ask that we pray real quick for them, OK?"

Hill's own addiction to painkillers led to a prescription fraud conviction in 2007 and a yearlong jail sentence that cost him a thriving church in Virginia Beach.

About four years ago, he came to Winchester and started Sunday services in the backroom of a downtown bar called Brewbaker's for a handful of people struggling with addiction. They'd drop a sheet over the liquor bottles before services.

It grew by attracting people like Matthew Fanning, who met Hill at a Narcotics Anonymous meeting.

Hill would talk about spirituality, but Fanning wasn't ready to hear it until he relapsed into heroin addiction. Hill visited him in rehab in 2015, encouraged him and gave him Bible-based homework.

Fanning is now in recovery and a Grace Downtown regular.

"You don't have to come in your quote-unquote Sunday best," Fanning said. "You come as you are, whether you're struggling, or whether you don't believe, or whether you're just curious."

The nondenominational church moved this year to a nearby strip mall with room to seat 400.

While some churches merely welcome the homeless, Grace Downtown picks them up in a van. Other worshippers come from local rehabilitation centers. Hill estimates that more than half who show up on Sundays are in recovery or related to someone who is.

"I have folks that come in that just got high the night before," Hill says. "I've got folks that overdosed the night before. I've got folks who have lost everything."
Never Stop Getting Our Hands Dirty
Pastor Jamie Casey prays with addicted people all over New Bedford, Massachusetts. He joins hands with them in their living rooms days after overdoses, in hospital emergency rooms and on sidewalks in front of wind-beaten houses in this struggling city.

The 45-year-old associate pastor in a nondenominational church is part of a team of clergy from a variety of faiths who regularly crisscross town with police officers and counselors. Their goal is to get people into treatment and, if they will listen, to offer some spiritual advice.

"Surrender," Casey told Brian Peets, who stepped out from his makeshift shelter beneath a railroad track platform.

"I can't," Peets said.

"Surrender," Casey repeated, alluding to his own addictions that started with alcohol and cocaine.

"For 20 years I fought and fought and fought against myself. Because you're your biggest enemy. You know that, right?" he told Peets. "So what ended up happening is that I ended up in a place that I lost almost everything. But then I had to surrender to this addiction, surrender to my circumstances, surrender to myself and then surrender to God."

New Bedford logged 56 opioid-related overdose deaths last year, a per-capita rate a third higher than nearby Boston. Police hope such outreach ride-alongs can get struggling people into treatment before the next setback.

The three-person teams cold-call homes where there have recently been overdoses to see if anyone wants help.

On a recent evening, Casey put on his shirt with "CHAPLAIN" on the back to ride with Officer Scott Carola and counselor Peter Lagasse around the city in an unmarked car.

Casey had a list of addresses of recent overdoses. But when they knocked on doors, most people either weren't home or weren't answering.

The trio was unfazed.

The person who ignores you today might embrace you tomorrow, said the Rev. David Lima, who heads the Inter-Church Council of Greater New Bedford and directs the program.

Only a small percentage will get treatment, but participating clergy contend that it's about more than numbers. Says Rabbi Raphael Kanter, quoting the Talmud, "if you save one life, it's as if you've saved the whole world."

They spotted James Sessine talking to friends on a busy corner outside a food market. The 29-year-old has struggled with addiction and recently has been living in a tent.

Sessine's friends scattered as the car stopped, but he stayed and listened to Casey's suggestion that he get a treatment slot.

Casey called a provider. Can they give him a time tomorrow? Yes.

Sessine got on the phone and promised he'll be ready the next morning, meanwhile, "I'm going to walk around all night, like I do every night."

Sessine ended the call and hugged Casey.

"I shoot heroin daily," Sessine explained a few minutes later, "and it's coming to the point where enough is enough."

Casey says his preaching, teaching and intervening is all part of his goal to "love people back to life."

"My best friend and I, we made a deal," Casey said, his voice catching. "He looked at me and he said, 'Promise me we'll never stop getting our hands dirty,' And I made that promise to him and God, because had people given up on me, I wouldn't be here."

They picked up Sessine the next morning.

Casey looked for Peets too, but could not find him.
Friars Flying the Jesus Flag
With his bushy beard and long gray robe cinched by a rope, the Rev. Giuseppe Siniscalchi would look at home illuminating manuscript in a monastery. But he and his fellow Franciscan friars are familiar figures on the sidewalks of Newburgh, New York.

They walk in pairs by row houses, empty storefronts and shoot-up spots in this Hudson River city. They offer people hot chocolate, iced tea or bagels along with their Roman Catholic blessings.

"When we approach the people on the street, whether they're addicted, whether they're even drunk, or whether they're high at the moment or they're a prostitute, whatever's going in in their life, we want to approach them first of all in love," Siniscalchi says.

On one afternoon walking with the Rev. Antonio Maria Diez de Medina, the pair greeted men on a street corner, a mom on her front steps and kids on scooters. Diez de Medina greeted some people in Spanish.

A dark-haired woman ran up to them from across the street and proudly told him about her recovery.

She acted calmly, different from when Siniscalchi saw her sitting restlessly in a parked car months ago. He offered to pray for her. The two friars laid a hand on her shoulders as they all bowed their heads on the sidewalk.

She closed her eyes so tightly her nose crinkled.

The friars are not specifically looking for people struggling with drugs, but they make a point of walking past some of the most troubled corners of Newburgh.

This once-grand city about an hour north of New York City has a poverty rate higher than that of the Bronx. For every fixed-up row house, there is another run down or abandoned. A hospital two blocks from the friary reported that it saved the lives of 205 overdose patients over a year's time.

"There been a few times where I've come across people with their little hypodermic needle kit ready to shoot up ... and you just say, 'Hi. How are you? How you doing,'" Siniscalchi says. "They kind of recognize or get a sense of who we are, and a conversation ensues."

The friars moved to an old church rectory here in 2016, establishing the St. Mary of the Assumption Friary. They take turns on the four-times-a-week walkabouts with Brother Peter Anthony Curtis.

In recent months, they started dispensing drinks from a metal cart they push down the streets. The rubber-wheeled cart sports a Jesus flag and a picture of Our Lady of Guadalupe, a resonant image in a city with a robust Hispanic population.

After two years, the sight of robed men with long beards chatting up people barely draws second glances. Quite a few people chat.

On one walk, a middle-aged bicyclist asked, "You guys Catholics or something?" He then had his silver crucifix blessed. A passing woman took a blue plastic crucifix that matched her clothes. At one point, Siniscalchi sat down next to a downcast woman, pulled out a crucifix and told her Jesus loves her.

"People don't," she replied, looking down.

That doesn't matter, he said, Jesus does.

After a few minutes, the friars said goodbye to go greet more souls.
___

Michael Hill is a multi-format AP journalist based in Albany, New York.

Copyright 2018 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Amid Drug Crisis, Spiritual First Responders Hit the Streets

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Jamie Casey, right, speaks with Brian Peets at a homeless camp in New Bedford, Mass., on Aug. 10, 2018. "For 20 years I fought and fought and fought against myself. Because you're your biggest enemy. You know that, right?" Casey told Peets. By MICHAEL HILL, Associated Press Sidewalk prayers near shoot-up spots.

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CURRENT EVENT 12

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LSD - known as acid and many other names - is a powerful hallucinogen that can produce a "high" for approximately 12 hours. While users are "tripping," they may experience not only a distortion of reality, but any number of physical or psychological side effects.

While LSD is not physically addictive, it can be extremely dangerous nonetheless - not to mention psychologically addictive, due to the feeling of euphoria it produces. While users may find some aspects of a high to be pleasant, people on LSD oftentimes exhibit poor judgment and create dangerous situations for themselves and others. Furthermore, a "bad trip" may trigger anxiety, paranoia and despair that can lead to self-harm and, in extreme cases, a suicide or homicide attempt. ¹

What Mental Health Disorders Can LSD Cause?

While these symptoms and inclinations typically only last while users are high, permanent psychological effects have resulted for some users - in some cases, after just one use. It has been determined that LSD can make existing mental health issues worse or cause latent mental disorders to emerge. ²

Underlying mental disorders usually increases a user's vulnerability to long-term psychological conditions. However, even those individuals who do not exhibit any sign of psychological irregularities prior to use may experience psychological issues after taking LSD. A couple such conditions include:

Psychosis

This is characterized by the loss of cognitive and communication skills, dramatic mood swings, delusions and hallucinations. With "persistent psychosis," a person experiences a series of continued mental issues, including disorganized thinking, visual disturbances, mood swings and paranoia. ³

Hallucinogen Persisting Perception Disorder (HPPD or hallucinatory "flashbacks")

This is characterized by ongoing sensory disturbances that are similar to those experienced while tripping on LSD. A chronic, debilitating condition, HPPD warps the perceptual faculties. After-images, image trails, bolts of light, snow-like sparkles and blobs of floating color are some of the possible visual drama that may accompany this condition.

LSD's psychotic episodes can trigger mental disorders, such as schizophrenia and bipolar disorder, in people who are genetically predisposed to them. ⁴

Do Psychedelics like LSD Pose a Paradigm Shift in Mental Health Care?

Some people who suffer from a psychological condition use LSD to escape their pain or problems. Because this drug can alter their emotions and perception of reality, it may bring some temporary relief or even clearer thinking. But what are the long-term effects? Do we know? Not really...not yet. Many who have conducted research studies in recent years are excited about the possibilities nonetheless.

Several medical journals have come out with reports suggesting benefits to patients with mental disorders. These reports highlight the "enormous potential of substances like LSD" in treating a variety of conditions.

Preliminary studies have shown that positive results can come from short courses - even single sessions - of psychedelic-assisted psychotherapy. "The studies are showing big effects," Dr. Matthew Johnson, a behavioral pharmacologist at Johns Hopkins University and one study's author.

LSD may be therapeutic for those with depression and other mental conditions because it can expose repressed emotions and thoughts. Even professionals who have extensively researched this theory say it would ideally be limited, monitored and used for short-term treatment. Attempting to treat depression or a mental disorder with LSD "on your own" could worsen symptoms; sudden exposure to repressed material can be very frightening and disturbing...possibly leading to rash decisions that could be disastrous. ⁵

Can LSD Addiction and Mental Disorders Be Treated Simultaneously?

Yes! Quality drug treatment centers like ours have the expertise and capabilities for serving patients with many co-occurring conditions. Dual diagnosis is the term for patients who are found to have multiple disorders.

Each interconnected health condition needs to be treated in a fully integrated, evidence-based program in order to achieve any long-term healing and recovery from these disorders individually.

Regardless of whether LSD has produced a mental disorder or your mental struggles have led you to LSD abuse, please be warned: Don't endanger your psychological health or the physical health of others any longer. Call our 24/7 toll-free line at 877-345-3299 , and we'll have information, treatment options and answers to all of your questions are readily available to you. No obligation or strings attached.

Situations like those we've described are too hazardous to handle on your own. Count on specialists who have shown excellence, trustworthiness and a tremendous amount of success. We care...one person at a time.
Sources
¹ "Hallucinogens and Dissociative Drugs", Research Report Series, National Institute on Drug Abuse, https://www.drugabuse.gov/sites/default/files/hallucinogensrrs.pdf , (January 2014).

² "Comorbidity of Mental Disorders and Substance Use", Dept. of Health & Ageing, Australian Govt., http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/FE16C454A782A8AFCA2575BE002044D0/$File/mono71.pdf.

³ "DrugFacts: Hallucinogens", National Institute on Drug Abuse, https://www.drugabuse.gov/publications/drugfacts/hallucinogens , (January 2016).

⁴ "A Trip that Doesn't End", The New Yorker, http://www.newyorker.com/tech/elements/a-trip-that-doesnt-end , (May 17, 2013).

⁵"Psychedelics Could Trigger a 'Paradigm Shift' in Mental Health Care", The Huffington Post, http://www.huffingtonpost.com/entry/psychedelics-mental-health-care_us_55f2e754e4b077ca094eb4f0 , (September 16, 2015).

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How LSD Abuse Complicates Mental Health Issues | The Canyon

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LSD - known as acid and many other names - is a powerful hallucinogen that can produce a "high" for approximately 12 hours. While users are "tripping," they may experience not only a distortion of reality, but any number of physical or psychological side effects.

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current Event 13

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Many mothers-to-be drink alcohol while expecting. There is little robust scientific evidence linking the occasional drink to health problems in children, but is one glass really safe?

Many pregnant women wonder if light drinking during pregnancy is safe.

As I near the halfway point of my second pregnancy, a new study - led by Loubaba Mamluk, a senior research associate in epidemiology at University Hospital Bristol in the United Kingdom - addressed this very question. The findings of that study are published this week in the journal BMJ Open.

In a meta-analysis of previous studies, Mamluk and her colleagues looked at the risk of light drinking during pregnancy on birth complications and the baby's health.

As Mamluk explained to me, "Women often ask about 'safe' levels of drinking during pregnancy - but one glass is OK, isn't it?"
"The distinction between light drinking and abstinence is indeed the point of most tension and confusion for health professionals and pregnant women, and public health guidance varies worldwide," she added.
The research team found an 8 percent increase in the risk of having a small baby and a 10 percent increase in the risk of preterm delivery in women who drank around two alcoholic drinks per week.

But there were no statistically significant effects on other factors, such as the baby's long-term health.

However, a lack of evidence does not necessarily mean that moderate drinking is safe. To help lift the fog of confusion around this issue, I delved deeper. Here is what I found.

Alcohol damages cells

Most people are familiar with the concept that excessive alcohol consumption is bad for our health. But what does alcohol actually do?

I am reminded of the destructive effects of alcohol from my early days as a Ph.D. student. As part of a routine experiment, I sterilized small glass slides - which I later planned to add cells to - so I could look at them under the microscope.

After soaking the slides in a 70 percent alcohol solution for 15 minutes, I promptly removed the liquid - or so I had thought. Unbeknownst to me, a small amount was left in the petri dish. I then made the critical mistake of adding the cells straight away, exposing them to the leftover alcohol.
The next day, widespread death awaited me.
Similar to the way in which the cells in my experiment were bathed in alcohol, in a pregnant mother, alcohol can readily cross the placenta from the blood to the growing baby.
But the developing fetus cannot break down alcohol as quickly as a fully grown adult can. This means that while we may have cleared the alcohol from our system, the baby remains exposed to it for much longer.
Longer exposure means more time for alcohol to wreak havoc and kill cells.

Heavy drinking causes damage

When pregnant women drink heavily and regularly, it can cause a range of life-long issues affecting between 1 and 2 percent of children. This is called fetal alcohol spectrum disorder (FASD).
The American Congress of Obstetricians and Gynecologists (ACOG) define heavy drinking as "three or more drinks per occasion or more than seven drinks per week."
FASD can affect children in many different ways. This is partly due to the fact that the speed with which alcohol is broken down varies from mother to mother, and the fact that alcohol exposure at different stages of pregnancy affects the developing baby differently.

The symptoms of FASD vary but can include an abnormal-looking face, poor learning and memory, hyperactivity, and difficulty in social situations.

While there is plenty of evidence linking heaving drinking to FASD, most pregnant women who do consume alcohol class themselves as low to moderate drinkers.

Who drinks how much, and where?

In the United States, 40 percent of pregnant mothers consume alcohol, of which between 3 and 5 percent report heavy drinking.

Looking across the globe, Irish women drink the most while pregnant (60 percent), closely followed by expectant mothers in Belarus (47 percent), Denmark (46 percent), and the U.K. (41 percent).
The National Institute on Alcohol Abuse and Alcoholism define one standard drink as 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirit, such as vodka. One such drink contains around 14 grams of pure alcohol.
But these alcohol units are not the same in every country. In the U.K., for example, one standard alcoholic drink contains 8 grams of alcohol.

While this may not be important for mothers who spend most of their time in a single country, it is a nightmare for scientists. It makes it very difficult to compare studies on alcohol consumption conducted in different countries.

Undeterred, Mamluk and her colleagues collated the data from 26 high-quality international studies and used statistics to identify the overall risk associated with light alcohol consumption - which is around two standard U.S. drinks or four standard U.K. drinks per week.

New systematic review of evidence

The team looked at a range of possible complications during pregnancy, including miscarriage, stillbirth, gestational diabetes, and birth defects, as well as signs of FASD after birth. But they only found significant associations with an increased risk of small birth weight (8 percent) and preterm delivery (10 percent).

Mamluk explained to me that the lack of good-quality studies shows how difficult it is to design meaningful research into the effects of alcohol during pregnancy.
"It also illustrates," she added, "the failure of researchers so far to focus on 'light' drinking versus no drinking, rather than just on moderate and heavy drinking - a question many expectant mums and healthcare providers care about."
Commenting on the research, Prof. David Garry - who is the director of maternal fetal medicine at Stony Brook Medicine in New York - told me, "This type of research is extremely difficult to perform. It is unethical to attempt to have a group of women intentionally drink, so researchers have limited approaches to study alcohol effects."

"We hope that this most up-to-date evidence will help empower women to make an informed decision about drinking during pregnancy."

Loubaba Mamluk

She continued, saying, "We emphasize that the evidence we have analyzed refers to light drinking, that the effects we have found are small, and that overall there is still some uncertainty, for example on how light drinking in pregnancy affects other aspects of the baby's health."

For Prof. Garry, who is a FASD Prevention Champion for the ACOG, total abstinence is the safest option. "It is clear that there is an association with alcohol consumption during pregnancy and [FASD]," he explained.

"It is also clear that harm from fetal alcohol exposure during pregnancy is completely avoided by not drinking during pregnancy."

Confusion can lead to stress

When I asked what advice Prof. Garry gives to his patients, he said, "I explain to potential pregnant women that drinking alcohol during pregnancy, including early pregnancy, can be harmful to their baby."

"If you think you are pregnant you should not drink," he added. "Women who are trying to become pregnant may not know if they are pregnant until several weeks after conception. You may wish to make a healthy choice and avoid drinking."
But with nearly half of all pregnancies in the U.S. being unplanned, many of these women drink alcohol before they are aware that they are pregnant. Once they do know, feelings of stress and guilt are not uncommon.
From Prof. Garry's point of view, a "[...] woman might miss her period but continue drinking with friends without considering she may be pregnant." But in his experience, "many women assess their lifestyle and make changes including: stop smoking, avoid soda, take vitamins, and avoid alcohol."

His message? "Avoiding alcohol can be considered one of the most healthy changes for a pregnant woman. No woman desires to harm their child. Using family and friends for support and positive reinforcement can help to reduce stress and avoid the harms of an alcohol-exposed pregnancy."

Personal choices during pregnancy

A healthful lifestyle during pregnancy is, of course, the best way to get a new baby off to a good start and speed up recovery after birth.

Both the ACOG and the Centers for Disease Control and Prevention (CDC) echo Prof. Garry's advice. They say, "There is no known safe amount of alcohol to drink while pregnant."
But Mamluk and her colleagues say, "Women who have had a drink while pregnant should be reassured that they are unlikely to have caused their baby considerable harm, but if worried, they should discuss this with their [doctor] or midwife."
The bottom line is that nobody is certain of the extent of harm that light drinking can cause a baby. In the absence of evidence, healthcare professionals and medical bodies err on the side of caution.

In the end, however, it comes down to personal choice. I made mine during my first pregnancy. It stood me in good stead, so I'm sticking with it this time around.

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Pregnant scientist investigates: Can I drink alcohol?

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Many mothers-to-be drink alcohol while expecting. There is little robust scientific evidence linking the occasional drink to health problems in children, but is one glass really safe? Many pregnant women wonder if light drinking during pregnancy is safe.

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Current Event 12

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Fentanyl-Laced Crack Cocaine a Deadly New Threat

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(HealthDay News, October 31) Fentanyl-laced drugs are behind a growing number of overdoses in the United States.

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Current Event 12

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A comprehensive worldwide study of alcohol use and its impact on health concludes that the safest level of consumption is zero.

A new study finds that drinking no alcohol at all is best for health.

The Global Burden of Disease Study 2016 has calculated levels of alcohol use and its effects on health during 1990-2016 in 195 countries.

The research, which now features in the journal The Lancet, notes that in 2016, alcohol use was responsible for almost 3 million deaths globally.
Alcohol use was the main cause of death for people aged 15-49 that year, accounting for 12 percent of deaths in men of that age.
"Our findings," says senior study author Dr. Emmanuela Gakidou, who currently works at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, "are consistent with other recent research, which found clear and convincing correlations between drinking and premature death, cancer, and cardiovascular problems."

She and her colleagues conclude that the "safest level of drinking is none." They explain that this is "in conflict with most health guidelines, which espouse health benefits associated with consuming up to two drinks per day."

Large variations in drinking patterns

More than 500 researchers, academics, and other collaborators from over 40 countries worked on the study.

To estimate global alcohol consumption, they used data from 694 studies and then used another 592 studies covering 28 million people to examine impact on health.
The results revealed that 32.5 percent of people worldwide drink alcohol. Among women, the proportion of those who drink is 25 percent, whereas for men it is 39 percent.
On average, women drink 0.73 alcoholic beverages per day, whereas men drink 1.7. The study defines a standard alcoholic drink as one that contains 10 grams of "pure ethyl alcohol."

This measure is somewhat less than that used in United States guidelines on alcohol consumption. These state that a standard drink has around " 14 grams of pure alcohol."

U.S guidelines typically give 14 grams, or 0.6 fluid ounces, as the amount to be found in a 12-ounce can of 5 percent beer, or 5 fluid ounces of 12 percent wine, or a 1.5 fluid ounce shot of 40 percent whisky, rum, and other spirits.
The study found large variations in drinking patterns among different countries. Denmark had the highest proportion of drinkers (97.1 percent of men and 95.3 percent of women), while Bangladesh and Pakistan had the lowest (0.3 percent and 0.8 percent, respectively).
Average levels of drinking were revealed to be the highest in Romania for men (8.2 drinks per day) and in Ukraine for women (4.2 drinks per day).

The lowest levels were in Pakistan for men (0.0007 drinks per day) and in Iran for women (0.0003 drinks per day).

'We need to act urgently'

The researchers calculated the health risk in people aged 15-95 years of consuming one alcoholic drink per day for 1 year compared with abstaining.

They revealed that this raised the risk of developing or experiencing 1 of the 23 "health problems" mentioned in the study by 0.5 percent.
At population level, this means that the number of individuals developing or experiencing 1 of the 23 problems over the course of a year is 918 out of every 100,000 for those who drink one alcoholic beverage per day, compared with 914 out of every 100,000 for those who don't drink.
The health problems covered in the study include:

cardiovascular disorders such as stroke and heart disease

several cancers, such as of the breast, liver, and parts of the digestive tract

diabetes, pancreatitis, and other non-infectious diseases

tuberculosis, respiratory, and other infections

unintentional injury

violence

self harm

traffic-related injury

"Previous studies," notes lead study author Dr. Max Griswold, who also works at the IHME, "have found a protective effect of alcohol on some conditions, but we found that the combined health risks associated with alcohol increase with any amount of alcohol."

'Change emphasis in alcohol guidelines'

Dr. Gakidou urges that governments need to alter policies so that they emphasize either "lowering people's levels of alcohol consumption or abstaining entirely."

In countries such as the U.S., public health information on alcohol and health tends to focus either on the dangers of excessive alcohol consumption or on keeping drinking to moderate levels.

There is often little mention of the fact that no consumption at all is the safest. For instance, the fact sheet on alcohol and health from the Centers for Disease Control and Prevention (CDC) starts with "[d]rinking too much can harm your health."

It then cites statistics about the effects of excessive drinking. During 2006-2010, excessive alcohol consumption in the U.S. resulted in around 88,000 deaths per year, cutting the lifespan of those who died by an average of 30 years. Among adults aged 20-64 years, it led to 1 in 10 deaths.

The 2015-2020 Dietary Guidelines for Americans advice on alcohol use opens with "[i]f alcohol is consumed, it should be in moderation" and then goes on to define moderate drinking as no more than two drinks per day for men and no more than one for women.

That being said, there is mention that the guidelines do "not recommend that individuals who do not drink alcohol start drinking for any reason."

"We now understand," says Richard C. Horton, who is editor-in-chief of The Lancet, "that alcohol is one of the major causes of death in the world today."

"We need to act urgently to prevent these millions of deaths," he adds.

"The myth that one or two drinks a day are good for you is just that - a myth. This study shatters that myth."

Dr. Emmanuela Gakidou

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The 'safest level of drinking is none,' says alcohol study

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A comprehensive worldwide study of alcohol use and its impact on health concludes that the safest level of consumption is zero. A new study finds that drinking no alcohol at all is best for health. The Global Burden of Disease Study 2016 has calculated levels of alcohol use and its effects on health during 1990-2016 in 195 countries.

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Current Event 15

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Hailey LeClair says she was about 12 years old when she started noticing her mother's drug use.

"She had been losing weight, and she hadn't really been home as much - she'd been out with friends," says Hailey, now 15.

In October 2017, the Bangor Daily News in Penobscot County, Maine, told Hailey's story, publishing diarylike entries she'd written that reflected feelings of frustration, confusion and hurt as she tried to navigate the effects of her mother's and stepfather's addictions.

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Those effects included separation from her younger sister, life with new guardians and the burning question of why her mother chose to use drugs such as heroin in the first place. And they occurred as Hailey was navigating the usual strains of finishing middle school and looking toward her first year of high school.

"I have more trust issues now since the whole incident," Hailey, a current sophomore at Old Town High School, tells U.S. News. "Our parents are supposed to be the No. 1 person there for you, and I kind of felt back-stabbed because I had no clue what was going on and I was completely oblivious for a while."

Hailey's experience underscores how the U.S. opioid epidemic has harmed people other than those suffering from addiction, particularly their family members. In fact, for an estimated 54.8 percent of Maine children who were removed by the state from their homes in 2016, parental alcohol or other drug use was a contributing factor for the removal, according to the National Center on Substance Abuse and Child Welfare. Nationwide, substance use increased as a factor for removal from 18.5 percent of cases in 2000 to 35.3 percent in 2016.

To help children and teens like Hailey in Maine's Penobscot and Piscataquis counties, the Department of Justice earlier this month awarded Penquis, a Bangor-based nonprofit organization, a three-year, $632,000 grant to establish social services geared toward them.

"We're seeing that there are a number of supports - though there are still gaps - for the parents, but it is the children that have been left behind primarily," Penquis CEO Kara Hay says. "Maine is a tight-knit community, so we don't want to see people dying, we don't want to see children being removed from homes anywhere, let alone (in) the two counties that this grant has been established to serve."

Hay says partners and community members will be coming together for the first time Monday to discuss how to use the grant money, with previously posited ideas including providing age-appropriate education on what to do if someone is overdosing; creating after-school mentoring and tutoring programs; offering access to basic supplies like food or a cellphone; and establishing safe locations for children to go to if they need help.

"This is about having our community say, 'This is what our needs are,' and especially our youth who know and are living this every day," Hay says. "For our community at large, we recognize that the more adverse childhood experiences that children live, the more difficult life they could potentially have in front of them. With that in mind, many of us strive for trauma-informed care in general, and work and develop our children and families to acknowledge those experiences and build on strengths moving forward."

Hailey's mother is going on two years sober after battling with her addiction for almost a year, and Hailey was able to move back in with her a little over a year ago. Her younger sister was expected to move home this past Sunday.

"Things are going really well," Hailey says, though it's not always easy. "I have stressful days where it's difficult to handle and then I have other days where I try my hardest because I know I don't want to end up like that," she says, referring to her mother's struggle with addiction.

Asked for her take on how groups like Penquis could better help kids in situations similar to hers, Hailey says: "Probably just listening to what (kids) have to say about it and trying to understand their perspective."

Katelyn Newman , Staff Writer

Katelyn Newman is a staff writer for the Healthiest Communities division at U.S. News & World R...Katelyn Newman is a staff writer for the Healthiest Communities division at U.S. News & World Report. You can follow her on Read more Twitter or reach her at knewman[at]usnews.com.

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Hailey LeClair says she was about 12 years old when she started noticing her mother's drug use. "She had been losing weight, and she hadn't really been home as much - she'd been out with friends," says Hailey, now 15.

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Tornado Watch: Bipolar Disorder and Alcoholism

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Tornado Watch: Bipolar Disorder and Alcoholism

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Current Event 13

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There are three main types of bipolar disorder: bipolar I, bipolar II and cyclothymic disorder.

For those living with bipolar disorder, this mood disorder is best described as a tornado violently ripping through your life with unpredictable episodes of mania and depression. Also known as manic depression, BD is characterized by emotional transitions between periods of euphoria/impulsivity and severe depression with hints of paranoia and anxiety. Extreme mood swings interfere with the functions of daily life at work, with family and other interpersonal relationships.
What Are the Symptoms of Bipolar Disorder?

Disorganized thinking (e.g., major evidence of clutter in the house and car)

Inappropriate responses to upsetting triggers (e.g., laughing hysterically when you should be sad)

Incessant, uncontrollable crying for no reason

Use of profanity when you generally don't curse at all

Restlessness and euphoria

Impulsivity (e.g., making large purchases on a whim)

Erratic behavior at work or inability to hold down a job

There are three main types of bipolar disorder: bipolar I, bipolar II and cyclothymic disorder. The first, bipolar I, usually requires psychiatric hospitalization in extreme circumstances, but symptoms vary widely from one person to another. The second, bipolar II, is a milder form, and cyclothymic disorder is characterized by brief episodes of depressive and manic symptoms. To cope with the emotional pain associated with bipolar disorder, individuals often turn to alcohol to numb feelings of worthlessness and suicidal ideations.
What's the Connection Between Bipolar Disorder and Alcoholism?
According to research, bipolar disorder is the highest-ranking co-occurring disorder associated with substance use disorders. Combined with alcoholism, or alcohol use disorder, individuals with SUDs are more likely to be hospitalized. Described as a complex comorbidity, bipolar disorder could be a drug-induced mood disorder or an affective disorder leading to substance abuse. According to Medscape, individuals with a family history of mood disorders are likely to develop BD after they start using or abusing drugs; if someone already has a pre-existing condition of BD, alcoholism would only worsen its clinical course.
How Is Bipolar Disorder Treated?
To effectively treat the comorbidity of bipolar disorder and alcohol use disorder, these must be addressed in the same setting, such as a dual diagnosis treatment center for substance abuse addiction. Evidence-based practices like psychotherapy and pharmacologic interventions are utilized by addiction professionals. Cognitive behavioral therapy is one such form of psychotherapy, which, according to the American Psychiatric Association, is synonymous with "talk therapy," a face-to-face treatment modality used to elicit self-disclosure.

Nutritional counseling is also commonly used as a natural, holistic alternative treatment for manic depression. Having a well-balanced diet is essential to managing moods, and a skilled nutritionist helps clients develop a meal plan that will inevitably improve their overall recovery.

Brook McKenzie, Contributor

Brook McKenzie serves as the Director of Clinical Outreach and Family Liaison for New Method We... Brook McKenzie serves as the Director of Clinical Outreach and Family Liaison for New Method Wellness. An experienced interventionist, Brook works directly with the family to facilitate an interruption of the loved one's active addiction cycle, discontinue enabling factors and help expedite the loved one's entry into treatment. Born and raised in East Texas, Brook's own family endured several years of pain and frustration at the hands of his addiction to drugs and alcohol. Today, he shares his past experiences freely with an eye toward mentoring families. Read more

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Tornado Watch: Bipolar Disorder and Alcoholism

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There are three main types of bipolar disorder: bipolar I, bipolar II and cyclothymic disorder. For those living with bipolar disorder, this mood disorder is best described as a tornado violently ripping through your life with unpredictable episodes of mania and depression.

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WHO: Excessive Drinking Killed Millions in 2016

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WHO: Excessive Drinking Killed Millions in 2016

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Current Event 12

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Drinking too much alcohol killed more than 3 million people in 2016, the World Health Organization reports.

Drinking too much alcohol killed an estimated 3 million people globally in 2016, and most of those deaths were men, according to a World Health Organization report on alcohol and health published on Friday.

Additionally, Europe experienced the highest proportion of deaths tied to alcohol, while countries in Africa bore the greatest burden of disease and injury because of alcohol consumption, according to WHO, the U.N.'s agency concerned with international public health issues.

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Men accounted for more than 2.3 million - more than 75 percent - of the alcohol-attributable deaths, according to the report's estimates. The authors said the large disparity between genders in part reflects men consuming more alcohol than women, as well as their higher likelihood of engaging in other unhealthy behaviors that are related to heavy alcohol consumption and binge drinking, like smoking tobacco or eating poorly.

Further, more than a third of alcohol attributable deaths were caused by intentional and unintentional injuries, such as car crashes and suicide.

While Europe recorded the highest level of alcohol consumption, the WHO's Africa Region experienced the largest alcohol-attributable burden of disease and injury, with 70.6 deaths and 3,044 disability-adjusted life years - DALYs or lost years of "healthy" life - per 100,000 people, according to the evaluation.

"The alcohol-attributable burden of disease and injury in Africa was due, in part, to the large burden of disease caused by tuberculosis, cardiovascular diseases, digestive diseases and injuries" to which alcohol is a contributing factor, according to the report.

Europe, the report's authors noted, had the largest proportional burden of all deaths and DALYs - more than 10 percent each - attributable to alcohol consumption. Meanwhile, the Eastern Mediterranean Region, including countries such as Saudi Arabia, Egypt, Pakistan, Lebanon and Morocco, experienced the lowest proportions of deaths and DALYs related to alcohol use, at less than 1 percent each.

Responsible for 5.3 percent of all deaths in 2016, the adverse effects of alcohol consumption were greater in 2016 than those of tuberculosis (2.3 percent), HIV/AIDS (1.8 percent), diabetes (2.8 percent), hypertension (1.6 percent), digestive diseases (4.5 percent), road injuries (2.5 percent) and violence (0.5 percent), according to the report.

The WHO report also said about 237 million men and 46 million women had alcohol use disorders that year, with the highest prevalences of alcohol problems for both men and women in Europe and the Americas.

Katelyn Newman , Staff Writer

Katelyn Newman is a staff writer for the Healthiest Communities division at U.S. News & World R...Katelyn Newman is a staff writer for the Healthiest Communities division at U.S. News & World Report. You can follow her on Read more Twitter or reach her at knewman[at]usnews.com.

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WHO: Excessive Drinking Killed Millions in 2016

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Drinking too much alcohol killed more than 3 million people in 2016, the World Health Organization reports. Drinking too much alcohol killed an estimated 3 million people globally in 2016, and most of those deaths were men, according to a World Health Organization report on alcohol and health published on Friday.

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What Happens During an Alcoholic Blackout?

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What Happens During an Alcoholic Blackout?

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Current Event 11

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People who experience blackout often cannot remember much of what happened while they were drunk.

Sarah Hepola experienced her first blackout from drinking when she was 11, at a party she attended with a female cousin she was close to. Hepola, who started stealing her parents' beer when she was about 6, chugged more than her share of suds and liquor at the bash. The next day, she was stunned and horrified when her cousin asked if she remembered removing her pants during the party.

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"I thought it was really insane," says Hepola, who's now 44 and eight years sober. "I was very modest. I didn't like undressing in front of people." That wasn't the only part of the night Hepola didn't remember. Her cousin told Hepola she'd also sat on some stairs and started crying. On the stairs, Hepola lamented that everyone loved her cousin more than they loved her.

It wouldn't be the last time Hepola, author of The New York Times best-seller "Blackout: Remembering The Things I Drank to Forget," couldn't remember chunks of her life she experienced while drunk. During Hepola's early adulthood, as a running joke she'd sometimes dump beer on the head of a male friend while proclaiming something jokingly hostile like "This is for the patriarchy!" Sometimes Hepola remembered the splashing; sometimes not. At times, Hepola's friends told her she'd drunkenly lifted her shirt to flash people. More than once, she woke up after a night of heavy drinking on a friend's couch, with no memory of how she got there. "It's like the brain suffers a mechanical failure," Hepola says. "The problem with all this is that it's funny in some ways and horrible in others. And it varies vastly depending on your context and perspective."

Blackouts are periods of amnesia during which a person engages in activities like walking, talking or dumping beer on a friend's head "but doesn't create memories for these events as they transpire," according to the National Institute on Alcohol Abuse and Alcoholism. There are two type of blackouts, says Jennifer E. Merrill, a research scientist and assistant professor at the Center for Alcohol and Addiction Studies in the Department of Behavioral and Social Sciences at Brown University in Providence, Rhode Island. "En bloc" blackouts can last for hours; in these blackouts, someone may not be able to recall large chunks of time. People who experience this kind of blackout may recall the initial parts of the drinking episode, before they've ingested the amount of alcohol that would disrupt their brain's ability to record memories, Merrill says. Fragmentary blackouts, also known as "brownouts" or "grayouts," can last a few minutes at a time and may involve a hazy or spotty memory of events. This kind of blackout is comparable to a camera that records for a while, loses power and goes dark, then blips back on again. A key difference between an en bloc and fragmentary blackout is that in the latter, a person can often recall something once prompted, Merrill says. He or she may not initially be able to recall a part of the evening, but will remember if a friend reminds him or her what happened. During both kinds of blackouts, some people may become sloppy and have a hard time standing or speaking intelligibly during a blackout, while others can outwardly seem fine and engage in coherent conversations without appearing impaired.

People who suffer from alcoholism, as well as their relatives and close friends and substance misuse clinicians, are well aware of the concept, which drew attention recently with the pitched battle over President Donald Trump's nomination of federal Judge Brett Kavanaugh for a spot on the Supreme Court. Christine Blasey Ford accuses Kavanaugh of sexually assaulting her during a party in the summer of 1982, when both were teenagers. Ford testified in a Senate hearing that Kavanaugh was drunk during the incident. Kavanaugh testified that he never attacked Ford and denied having a drinking problem. He also denies allegations from two other women who accuse him of drunken sexual misconduct in high school and in college.

While Ford's account and Kavanaugh's vehement denials seem to suggest one of them is lying, some observers have discussed the theory (which Hepola wrote about in a New York Times opinion piece) that both could have testified truthfully. Under this hypothesis, Kavanaugh may not recall what happened during the night in question and believes the allegation is false.

Some people confuse alcohol-induced blackouts with passing out from excessive drinking, but they're two different things, says Reagan R. Wetherill, a research assistant professor of psychology in psychiatry at the Perelman School of Medicine at the University of Pennsylvania. Wetherill has researched blackouts. "During a blackout, a person is able to actively engage and respond to [his or her] environment," Wetherill says. "However, the brain is not creating memories for the events. Essentially, alcohol alters and impairs memory formation by suppressing activity within the hippocampus and other regions of the brain involved in the transfer of information from short-term to long-term memory." A heavy drinker can be in a blackout and not pass out, says Dr. Harshal D. Kirane, director of addiction services at Staten Island University Hospital, part of Northwell Health in Staten Island, New York. "Not all blackouts end in passing out," he says.

Blackouts are associated not just with drinking an excessive amount of alcohol, but consuming it quickly, Kirane says. There's no baseline amount of drinking that will cause someone to have a blackout, Kirane says. It varies from person to person, based on such factors as an individual's size and his or her tolerance for consuming alcohol. Genetics can play a role, because some people are genetically predisposed to experiencing blackouts, Kirane says. Once someone has experienced a blackout, he or she is more vulnerable to having future episodes of such memory loss, Kirane says. That's because biological changes occur in the brain that can lower its threshold for experiencing another blackout.

Being in a blackout can be dangerous - for the person experiencing it and for those around him or her. "It's an incredibly vulnerable place where someone won't be able to respond to potential threats or dangers, or to regulate their behaviors and emotions as they would in a sober state," Kirane says.

Not knowing how she behaved during a blackout was unsettling, Hepola says. She considered herself a "happy drunk" who freely handed out compliments while inebriated. But after a handful of drinking episodes, some people told her how rude she was the previous night. "That totally ran against how I saw myself," she says.

Hepola developed strategies to try to piece together what happened after a blackout. "You wake up and look back on the night and look for pieces [of information] that might be missing," she says. "I'd look for pieces of evidence that didn't fit my memory: a hand stamp to a bar I didn't remember going to. A pizza box in the middle of the room. A refrigerator door that's flapping open. That would be the first sweep of information." If she remembered she'd been with a close friend the previous night, she might text or call her or him, acknowledge blacking out and ask: "Did I do anything weird?" Or she'd send "fishing texts," complimenting friends for throwing a great party and adding, "The part that I could remember was great." Hepola says she could tell from the response whether her friend was mad at her or everything was OK. "I think it's really hard for people to get their head wrapped around that, that you can have a shared experience but only one person will remember," she says. "It was very spooky for the person I'd been talking to. They'd wonder, 'Who was I talking to if you don't even remember?'"

Ruben Castaneda, Staff Writer

Ruben Castaneda has worked at U.S. News since September 2016. Mr. Castaneda has written extensi... Read more Ruben Castaneda has worked at U.S. News since September 2016. Mr. Castaneda has written extensively about Baby Boomer health and exercise habits, strategies for losing weight, health care issues affecting distressed communities, yoga and substance misuse. In 2018, the National Press Foundation chose Mr. Castaneda as one of 15 journalists nationwide to participate in a deep dive seminar into reporting on the opioids crisis.

In 2017, the USC Center for Health Journalism named Mr. Castaneda one of 24 journalists chosen from around the nation to participate in the center's National Fellowship. Mr. Castaneda was awarded a grant from the Dennis A. Hunt Health Journalism Fund. The grant helped support Mr. Castaneda's reporting for a five-part series U.S. News published focusing on how the Trump administration's immigration policies are affecting the health and well-being of children of immigrants, their parents and health care providers and teachers who work with the kids. He has appeared multiple times on "Just Ask David," a podcast that covers health and beauty issues.

Before joining U.S. News, Mr. Castaneda worked as a reporter for 22 years at The Washington Post, where he primarily covered crime in the District of Columbia and courts and police misconduct in Prince George's County, Maryland. His 2014 nonfiction book, "S Street Rising: Crack, Murder and Redemption in D.C." chronicles Mr. Castaneda's struggle with crack addiction while covering the crime beat for the Post during the violent crack era. The Post named "S Street" one of 50 notable works of nonfiction published that year. Mr. Castaneda has also appeared on NPR, CNN's "Reliable Sources" and on several local TV news shows .

He has written for Politico, Washington City Paper, Los Angeles Weekly and Hispanic Magazine. Mr. Castaneda is a member of the Association of Health Care Journalists and the National Association of Hispanic Journalists. Mr. Castaneda graduated with a degree in journalism from the University of Southern California and completed a six-week fellowship at Duke University, part of a partnership with The Post.

You can follow Mr. Castaneda on Twitter, and LinkedIn, or learn more about him on Wikipedia.

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People who experience blackout often cannot remember much of what happened while they were drunk. Sarah Hepola experienced her first blackout from drinking when she was 11, at a party she attended with a female cousin she was close to.

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Drug Spending: A Power Struggle Between States, Federal Government

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Drug Spending: A Power Struggle Between States, Federal Government

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current Event 10

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Although states are limited in what they can do to control prescription drug costs, they still have the ability to negotiate with drug companies and seek additional discounts.

States serve as "laboratories of democracy," as U.S. Supreme Court Justice Louis Brandeis famously said. And states are also labs for health policy, launching all kinds of experiments lately to temper spending on pharmaceuticals.

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No wonder. Drugs are among the fastest-rising health care costs for many consumers and are a key reason health care spending dominates many state budgets - crowding out roads, schools and other priorities.

State-based experiments may carry even greater weight for Medicaid, the federal-state partnership that covers roughly 75 million low-income or disabled Americans.

Massachusetts planned to exclude expensive drugs that weren't proven to work better than existing alternatives. The state said Medicaid drug spending had doubled in five years. Massachusetts wanted to negotiate prices for about 1 percent of the highest-priced drugs and stop covering some of them. CMS rejected the proposal without much explanation, beyond saying Massachusetts couldn't do what it wanted and continue to receive the deep discounts drugmakers are required by law to give state Medicaid programs.

The Medicaid discounts were established in 1990 law based on a grand bargain that drugmakers say guaranteed coverage of all medicines approved by the Food and Drug Administration in exchange for favorable prices.

The New England Journal of Medicine dives into the CMS decision regarding Massachusetts and its implications for other state Medicaid programs in a commentary by Rachel Sachs, an associate professor of law at Washington University in St. Louis, and co-author Nicholas Bagley. They dispute the Trump administration's claim that Massachusetts' plan would violate the grand bargain.

We talked with Sachs about Massachusetts' proposal and the implications for the rest of the country. Her answers have been edited for length and clarity.
Why do you think states, such as Massachusetts, should be allowed to exclude some drugs, a move the pharmaceutical industry has said would break the deal reached back in 1990?
In our view, there's a way to frame it where the bargain has been broken and Massachusetts is simply trying to restore the balance. The problem is that the meaning of FDA approval has changed significantly over the last almost 30 years. Now we have a lot more drugs that are being approved more quickly, on the basis of less evidence - smaller trials, using surrogate endpoints - where the state has real questions about whether these drugs work at all, not only whether they are good value for the money.
You suggest that Massachusetts could make a reasonable case if it chose to challenge the CMS denial. How?
CMS did not explain why it didn't grant Massachusetts' waiver. It needs to give reasons for denying something that Massachusetts, in our view, has the legal ability to do. CMS' failure to give reasons in this case resembles their failure to give reasons in a number of other cases that have recently led courts to strike down actions by the Trump administration for failure to explain the actions that they were taking.

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(Note: A spokeswoman for Health and Human Services in Massachusetts says the state is not going to challenge the CMS decision.)
While CMS blocked the Massachusetts experiment, it has approved the value-based purchasing plan in Oklahoma, and New York has capped its Medicaid drug spending. Aren't those signs of flexibility for states?
In some ways, yes, and in other ways, no. New York passed a cap on state Medicaid pharmaceutical spending. But once the state hits that cap, it doesn't mean the state will stop paying for prescription drugs. It just means the state is empowered to negotiate with some of these companies and seek additional discounts. They didn't need CMS approval for this. New York doesn't have the ability to say "If you don't take this deal, we're not going to cover this product."

Oklahoma is pursuing outcomes-based pricing, which is of interest. It's the first state to express interest in doing so. However, there are a lot of observers who are skeptical that outcomes agreements of this kind will materially lower prices or if they just provide companies cover to charge higher prices in the first instance.
So what options do you see ahead for states given what happened in Massachusetts with the Medicaid waiver?
Unfortunately, states are quite limited in what they're able to do on their own, in terms of controlling prescription drug costs - both costs that are borne by the state in its capacity as a public employer and its capacity as an insurer for the Medicaid population. and then more generally for the many citizens who are on private insurance plans throughout the state.

This is a real problem, this concern of federal pre-emption where states' ability to go beyond federal law is often limited. So what we're seeing now is more states like Massachusetts and Vermont taking action that forces the federal government to do something or say something. States are increasingly putting pressure on the federal government because they know that their ability to act on this problem of drug pricing is limited.
Martha Bebinger wrote this article for Kaiser Health News (KHN), a nonprofit national health policy news service. It has been reprinted with permission.
Kaiser Health News, Contributor

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide...Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation and is not affiliated with Kaiser Permanente. Read more

More Healthcare of Tomorrow News

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States and Federal Government Attempt to Control Medicaid Drug Spending

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Although states are limited in what they can do to control prescription drug costs, they still have the ability to negotiate with drug companies and seek additional discounts. States serve as "laboratories of democracy," as U.S. Supreme Court Justice Louis Brandeis famously said.

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Are Older Adults Taking Benzodiazepines Safely?

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Are Older Adults Taking Benzodiazepines Safely?

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Sedation, dizziness and weakness are among the most common benzodiazepine side effects.

If you're feeling anxious or sleeping poorly, it's tempting to turn to pills to solve the problem. However, prescription sedative drugs known as benzodiazepines carry significant risks, particularly for older adults.

Many people in their 60s, 70s and 80s take antianxiety medications - such as Xanax, Valium and Ativan - sometimes indefinitely. Sleeping pills - such as Halcion and Restoril - meant for short-term use can turn into long-term habits.

Sedation, dizziness and weakness are among the most common benzodiazepine side effects. Depressed mood, headaches, memory problems and irritability can also occur.

Disorientation, balance problems, daytime drowsiness and increased risk of injuries - like falls - are also benzodiazepine side effects. The very problems older adults hope to avoid, such as mental confusion or hip fractures, become more likely.

Even so, physicians keep writing and refilling these prescriptions for their older patients. A new study finds that many patients take benzodiazepine drugs for months on end.

When the generic name of a drug ends with "pam" or "lam," that indicates it's a benzodiazepine.

Valium (diazepam), Ativan (lorazepam) and Xanax (alprazolam) are common medications for treating anxiety disorders. Klonopin (clonazepam), used to control and prevent seizures, is also prescribed for panic attacks. For sleep problems, benzodiazepines approved by the Food and Drug Administration are flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), triazolam (Halcion) and Estazolam (estazolam).

Benzodiazepines are thought to work by affecting chemicals in the brain called neurotransmitters, which communicate with nerves in the body. These drugs appear to enhance the calming effects on the nerves.
Overprescribing to Older Adults
A new review published in the September/October 2018 Harvard Review of Psychiatry looked at evidence of effectiveness and tolerability among older adults with three conditions for which benzodiazepines are commonly prescribed: insomnia, anxiety disorders and dementia symptoms.

For insomnia treatment, 21 of 25 studies showed improved sleep outcomes with use of benzodiazepines. For anxiety, the single related study found a benefit with benzodiazepines when compared to placebos. For behavioral disturbances in dementia, only one of five studies showed improvement compared to placebos.

Overall, the review found that "benzodiazepine prescribing in older adults is significantly in excess of what the available evidence suggests is appropriate," according to research led by Dr. Lauren Gerlach, an assistant professor with the University of Michigan's department of psychiatry.
Staying on Drugs Too Long
Taking benzodiazepines over a long period is problematic, but it's common among older adults, according to another study, also led by Gerlach. Released in September in JAMA Internal Medicine, it focused on nearly 600 adults with an average age of 78 who were newly prescribed benzodiazepines or sedatives.

"We looked at folks who were started on medications by non-psychiatric providers and followed them over the next year." Gerlach says. "We found nearly one in four stayed on these medications long-term. Most of these medications for older adults are really recommended for short-term, if any, use."

Short-term use varies with the patient's condition and symptoms, Gerlach notes. For most people, she says, you would expect roughly one to three months for these medications. However, she says, "Most of the people who were staying on these medications long-term were receiving at least eight months of medication over the following year."

Among study participants, those who received more pills with their first benzodiazepine prescription were more likely to become extended users. "For only 10 additional days of supplied medicine, that almost doubled the patient's risk of continuing into long-term use over the next year," Gerlach says.

Benzodiazepines carry "a host of side effects" for anyone who takes them, Gerlach says. However, risks are amplified for older adults, she says, given changes in how their bodies metabolize, or break down, medications.

Using benzodiazepines to treat people with dementia is not particularly helpful. "Despite benzodiazepines being widely prescribed to patients with behavioral disturbances in dementia, there is little evidence to show that these medications provide any benefit other than sedation," Gerlach says.

If anything, with this class of drugs, "There's been some evidence to show that they can worsen our thinking or cause confusion," Gerlach says. "They may even be linked to an increased risk of developing dementia."

Deaths involving benzodiazepines have been rising, with an eightfold increase from 2002 to 2016, according to the National Institute on Drug Abuse.

While the opioid epidemic draws the spotlight, benzodiazepines come second in terms of dependence and overdose risk. Benzodiazepines are involved in more than 30 percent of opioid-related overdoses, according to the NIDA. Because both types of drugs suppress breathing, taking them together is dangerous.

There are signs of increasing awareness. A study encompassing adults ages 65 and older in the U.S., Australia and Ontario, Canada, found significant decreases in use of benzodiazepines for U.S. and Canada between 2010 and 2016. The prevalence of usage among older U.S. adults dropped from 9.2 percent to 7.3 percent during that period, according to the study published February in the Journal of the American Geriatrics Society. However, use remains "inappropriately high," authors noted, particularly among adults ages 85 and older.

According to the most recent Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, an authoritative set of guidelines from the American Geriatrics Society, benzodiazepines are among the medications to be avoided if possible, although they may be appropriate in some cases.

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Along with memory impairment, falls, fractures and motor vehicle accidents, these drugs are responsible for a significant number of avoidable hospital admissions and emergency department visits, as noted in a May 2015 study in the Journal of Psychiatry and Neuroscience that focused primarily on the use of benzodiazepines to treat insomnia.

Many misconceptions surround sleep, says study author Dr. Cara Tannenbaum, a professor in the faculties of medicine and pharmacy at the University of Montreal. In her work as a geriatrician and consultant, sleep concerns frequently come up in discussions with older patients.

"A lot of people would like to sleep 12 hours a night," Tannenbaum says. "But after the age of 65, your sleep architecture changes and that's not a realistic expectation." It doesn't make sense to medicate patients for perfectly normal sleep patterns, she says. Sleeping only six or seven hours a night, maybe waking up once or twice during that time, is typical for many older adults.

How can you tell if benzodiazepines (or other sedatives like Ambien) are becoming a problem for a family member? Tannenbaum points out possible clues:

Repeating the same question twice in a short period of time

Being off the current date by a day or two and mixing up times for appointments

Forgetting where they parked the car, or misplacing keys, and then being unable to locate them fairly quickly

Driving and missing the street

Stumbling a bit while getting up from a chair

"If somebody told you that they fell, but, 'Don't worry; I was fine,'" that could be a sign, Tannenbaum says. "Maybe the next time they won't be fine."

Medication from a nighttime sleeping pill can linger in the bloodstream until noon or 1 p.m. the next day, Tannenbaum warns. The effect is much worse for women, she adds, as pills remain in the body longer for physiological reasons. Frail, older women face the highest risk of all.
Coming Off Benzodiazepines
Older adults may need help to gradually come off benzodiazepines. For everyone, safer treatments and more effective methods exist to reduce anxiety and improve sleep.

Deprescribing involves stopping or decreasing medications that aren't helping patients and may be hurting them. "We always try to deprescribe benzodiazepines," says Tannenbaum, who is the director of the Canadian Deprescribing Network. It's not safe to quit these drugs abruptly, she adds: "It really has to go slowly because you could have withdrawal symptoms."

The deprescribing process must be done with help from your doctor, nurse or pharmacist, the CDN website emphasizes. The site provides a tapering-off schedule to be followed under the supervision of a health care professional.

If you're having serious trouble falling asleep, a form of counseling called cognitive behavioral therapy could help you get a good night's sleep without medication. With CBT, you learn techniques such as setting a consistent bedtime and wake time, avoiding naps and using your bed for sleep and sex only. Relaxation training and biofeedback also help, as well as tweaking your sleep environment - such as keeping it quiet and cool, and avoiding bedroom clutter.

Anxiety can also be treated more safely. A combination of an antidepressant drug and cognitive behavioral therapy would be recommended as a first-line treatment before the use of a benzodiazepine medication, Gerlach says.

When it comes to benzodiazepines, Gerlach says, it's important for health care providers to be cautious with the initial prescription. Prescribers should focus on short-term use of the medications, she says, and immediately begin the discussion with patients about when to re-evaluate their symptoms, start reducing the medications and eventually come off these drugs.

Lisa Esposito, Staff Writer

Lisa Esposito has been a patient advice reporter for U.S. News since 2014, writing about medica... Read more Lisa Esposito has been a patient advice reporter for U.S. News since 2014, writing about medical and mental health conditions, healthy aging and how patients can receive better hospital care. Prior to joining U.S. News, Ms. Esposito was editor of the Health Behavior News Service, editor of the Baltimore/Washington edition of Gannett's Nursing Spectrum and a freelance editor with HealthDay News.

While at U.S. News, Ms. Esposito has appeared on panels, reported on and contributed to media guidelines on responsible suicide coverage at the U.S Department of Health and Human Services and the Pentagon. In 2016, she won a Media Orthopaedic Reporting Excellence award. Previously, Ms. Esposito worked as a registered nurse in multiple hospitals, starting at the University of Maryland Cancer Center and ending at the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

Lisa Esposito graduated with a bachelor's degree from the University of Maryland School of Nursing and a master's degree in journalism from Georgetown University. She is a member of the Association of Health Care Journalists. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.

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Are Older Adults Taking Benzodiazepines Safely?

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Anxiety and sleeping medications including Xanax, Valium and Halcion are being overprescribed, and seniors are more vulnerable to side effects.

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AP Analysis: 'Obamacare' Shapes Opioid Grant Spending

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AP Analysis: 'Obamacare' Shapes Opioid Grant Spending

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By CARLA K. JOHNSON and NICKY FORSTER, Associated Press

With Republicans and Democrats joining forces again in a bipartisan effort to target the U.S. opioid crisis, an Associated Press analysis of the first wave of emergency money from Congress finds that states are taking very different approaches to spending it.

To a large extent, the differences depend on whether states participated in one of the most divisive issues in recent American politics: the health overhaul known as "Obamacare."

The AP analysis found states that expanded Medicaid under President Barack Obama's health overhaul reported spending their allocations more slowly than states that didn't expand the health insurance program to poor, childless adults.

Why? In states that expanded Medicaid, the insurance program already covers addiction treatment for nearly everyone who is poor and needs it.

Medicaid allows states to go beyond the basics with the grant money, while non-expansion states have to fill in for basic needs with fewer dollars, said Brendan Saloner, an addiction researcher at Johns Hopkins Bloomberg School of Public Health. In effect, Medicaid expansion states had a running start on the opioid crisis, while states without the extra Medicaid funding hastened to catch up.

"Non-expansion states are dealing with populations more likely to be uninsured and more likely to need coverage for addiction treatment," Saloner said. In contrast, states with Medicaid expansion can use the grants to create new infrastructure, "asking providers to take risks by investing in new personnel, new systems and new ways of doing things," Saloner said. "The puzzle is how to keep momentum going after the funds are gone."

The Medicaid insurance expansion gives states a head start because they have "a coordinated, reliable and consistent source of coverage" for a demographic group hit hard by addiction, said Trish Riley, executive director of the National Academy for State Health Policy. "It's not grant funded. It's not stopgap," Riley said.

"Coverage matters, period," Riley said.

Thirty-three states have expanded Medicaid, receiving enhanced federal funding to cover poor adults. Historically, Medicaid has covered a large share of all addiction treatment in the U.S., more than all private insurance combined. Medicaid covers 4 out of 10 adults under age 65 with opioid addiction.

On Election Day, voters in Idaho, Nebraska and Utah will decide whether their states should expand Medicaid. Montana voters will decide on maintaining that state's expansion.

The emergency money from Congress was part of a two-year, nearly $1 billion grant program. It was distributed according to a formula favoring states with more overdose deaths and treatment needs. California received nearly $45 million. Texas got $27.6 million. Florida got $27.2 million.

States spent the money at different paces and on different services, the AP found. In total, states used the money to provide treatment to nearly 119,000 people with opioid addiction, including nearly 3,000 pregnant women. More than 33,000 people received recovery services, such as training and housing.

In Massachusetts, with Medicaid expansion already paying for treatment, the grant goes largely toward such recovery services. Phillip Oliver, a 48-year-old who has struggled with addiction since his early teens, is training to work in the restaurant industry; his tuition is covered by the grant.

Michael Robinson, who is in recovery from heroin addiction, got a care services coordinator, a $500 benefit and a six-week training program in construction. Two months ago, the 25-year-old became a union carpenter and has been working on building projects across the Boston area since.

"It's a great thing they're doing," Robinson said. "The reason a lot of people stay getting high is they have nothing to look forward to. They don't have the jobs skills and the streets are all they know."

Tennessee, which has not expanded Medicaid, is spending its grant at a quicker pace than most other states, filling empty slots at treatment facilities that were instantly ready for more clients. One is Buffalo Valley Inc. with 14 locations around the state.

Thanks to the federal grant, Buffalo Valley is treating an additional 1,000 people a year with opioid addiction and without insurance. People like Tim Nolen, 36, of Nashville.

"I see it as a blessing," said Nolen, who after years addicted to pain pills is making progress with medication and counseling. "The biggest thing for me was, not having insurance, I could still get help and I didn't have to go bankrupt to get it."

The AP obtained the spending data via a Freedom of Information Act request filed with federal health officials.

The 12 months of spending totaled $270 million, a portion of the $1 billion Congress approved in 2016 to address opioid addiction under the 21st Century Cures Act.

To compare states, AP obtained year-end reports and analyzed actual expenditures from May 2017 through April 2018. States were required to report on money actually spent, not what they intended to spend.

In some states, structural delays - choosing contractors through competitive bidding, for example - led to less time for invoices to be submitted and paid by the end of the period. California officials said such processes and a deliberate effort to build an entirely new treatment structure explain why the state still had $41 million of its grant left after the first 12 months.

-States that did not expand Medicaid spent $2,645 per patient on opioid addiction treatment on average. Expansion states spent $1,581 per patient for treatment.

-States that did not expand Medicaid spent $1,170 per person served on recovery support services. Expansion states spent $446 per person served on recovery.

-States that did not expand Medicaid spent 71 percent of their grant money in the first year. Expansion states spent 59 percent of their grant money. States can get permission to carry over unspent money into the next year.

Virginia and Maine were counted as non-expansion states in AP's analysis because neither state's expansion was implemented in time to affect grant spending.

Federal officials said states had some leeway in how they categorized money spent but also got some guidance. For instance, states were instructed to categorize the opioid overdose drug naloxone under the "treatment" category.

It's too early to pinpoint whether the spending may be helping solve the crisis. The Trump administration has said a recent survey shows efforts are working. Fewer people used heroin in 2017 for the first time than the previous year. Fewer were misusing or addicted to prescription opioid painkillers. And more people were getting treatment for heroin and opioid addiction. The Centers for Disease Control and Prevention has released preliminary figures that appear to show a leveling off in overdose deaths.

In the shadow of the bitter fight over Brett Kavanaugh's Supreme Court confirmation, Congress passed the bipartisan Support for Patients and Communities Act, which includes multiple provisions to address the opioid crisis and reauthorizes the Cures Act grants through 2021. President Donald Trump is expected to sign the measure.

Debbie Hillin of Buffalo Valley in Tennessee said she worries Congress won't continue the grants beyond that.

"It's an overwhelming concern. I still got people calling every day that I can't get into treatment services," Hillin said.

Johnson is an Associated Press medical writer and Forster is an AP data journalist. Associated Press writer Philip Marcelo contributed from Boston.

The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content.

Copyright 2018 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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AP Analysis: 'Obamacare' Shapes Opioid Grant Spending

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With Republicans and Democrats joining forces again in a bipartisan effort to target the U.S. opioid crisis, an Associated Press analysis of the first wave of emergency money from Congress finds that states are taking very different approaches to spending it.

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How Bad Is It Really to Drink While Taking Antibiotics and Other Meds?

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How Bad Is It Really to Drink While Taking Antibiotics and Other Meds?

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Current Event 7

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Warning: Do Not Use With Alcohol

You're about to order your first beer of the night when it hits you: You've been taking antibiotics for a few days to treat a no-longer-bothersome travel bug. Are you even "allowed" to drink? Maybe, maybe not. "Alcohol is a drug, so anytime you combine one drug with another, you're at risk for drug interactions," says Jocelyn Kerl, a pharmacist in Madison, Wisconsin, including those that enhance the medication's side effects or slow or speed up how the body processes it. But the severity of potential interactions varies greatly. Here's a look at some common medicines and what can happen - if anything - if you drink moderately while taking them:

Antibiotics

Whether an antibiotic cooperates with cocktails depends on the drug itself. Metronidazole, which is sold as Flagyl and often used to treat the sexually transmitted infection trichomoniasis, for example, is dangerous to booze on since it can cause vomiting and other severe symptoms, Kerl says. Folks on ketoconazole (sold as Nizoral for skin infections) and isoniazid (sold as Nydrazid for tuberculosis) also need to stay away from alcohol to avoid potential liver damage, according to the National Institute on Alcohol Abuse and Alcoholism. While many other antibiotics are generally safe for moderate drinkers, check with a pharmacist first and, if cleared, space out when you take each, advises Mohamed Jalloh, a spokesperson for the American Pharmacists Association.

Anna Medaris Miller, Staff Writer

Anna Medaris Miller is a Senior Health Editor at U.S. News, where she covers fitness and athlet... Read more Anna Medaris Miller is a Senior Health Editor at U.S. News, where she covers fitness and athletic performance; nutrition and fad diets; "invisible" medical conditions; complementary medicine, reproductive health; mental health; gender, sexuality and body image issues; and more. She also manages the Eat+Run blog, a practical guide for healthy living.

Before joining U.S. News in 2014, Anna was an associate editor for Monitor on Psychology magazine and freelanced for the Washington Post. Her work has also appeared in the Huffington Post, Women's Health, Yahoo!, Business Insider, the Muse and more.

Anna frequently acts as a health expert and spokesperson for U.S. News on national and local TV and radio, and has appeared on the Today Show, Good Morning America, Fox 5 New York and more. She has held leadership positions on the National Press Club's young members committee, the Association of Health Care Journalists' D.C. chapter and the American News Women's Club.

Anna graduated Phi Beta Kappa from the University of Michigan, where she studied psychology and gender and health, and later earned her master's degree in interactive journalism from American University. Anna lives in New York City and is a multi-time triathlete and marathoner currently training for an IRONMAN 70.3. To learn more about Anna, visit her website or follow her on Facebook, Twitter, LinkedIn or Instagram.

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How Bad Is It Really to Drink on Antibiotics?

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Warning: Do Not Use With Alcohol You're about to order your first beer of the night when it hits you: You've been taking antibiotics for a few days to treat a no-longer-bothersome travel bug. Are you even "allowed" to drink? Maybe, maybe not.

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Current Event 6

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It was 3 a.m., and he'd been driving all over in search of an addiction treatment center. Earlier that day in 2017, he'd been fired from his insurance job when his boss discovered he'd stolen $40, which he'd used to buy black-market prescription opioids. But at Mass General, the Rhode Island resident found the supportive environment he needed to get well, mainly because he could enter a treatment program right away without having to get sober first.

"The nurse was very empathetic," says Arment, who became hooked on Percocet pills a few years after college. She referred him to the hospital's Bridge Clinic, which enrolled him in an outpatient recovery program within hours.

The Bridge Clinic suited Arment because he was immediately put on Suboxone (buprenorphine) to stop withdrawal symptoms and curb cravings. He spent the next few months attending support groups, meeting with doctors and psychiatrists, and getting peer counseling from a recovery coach and former addict.

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"It was incredibly helpful to have someone to talk with who has been in my shoes," says Arment, who remains clean and manages the wire transfer department at a bank's corporate office. The clinic "literally saved my life."

Even after patients like Arment have detoxed and been stabilized, they still need more help. But they and others in different stages of treatment often face lengthy waitlists for programs designed to sustain their recovery - at a time when they are particularly vulnerable to relapse or overdose - and many such programs are so highly structured that people with active addiction can't meet the requirements, experts say.

The Bridge Clinic, founded in 2016, is intended to fill that gap. It uses a flexible, immediate-access approach that welcomes walk-ins at any stage of illness or readiness, removing a barrier to treatment. No one is turned away.

The Bridge team also provides same-day access to medications. (Patients also get individualized medical care and other support services, including peer support, clothing and transportation assistance.) Although critics say using medication for the treatment of substance use disorders merely substitutes one addiction for another, it has become the standard of care because strong evidence indicates these medications are effective in helping prevent relapse and enable many people to return to normal functioning.

"A lot of the work we do is simply treating people with respect and compassion and letting them start wherever they think they can," says Laura Kehoe, the clinic's medical director. "If we don't treat the acute craving and withdrawal, they'll self-treat and relapse. But no one is ever kicked out of this clinic for active drug use."

The Bridge Clinic is part of an innovative Mass General initiative to identify people with substance use disorders, treat them and transition them to community programs for ongoing addiction care. It's just one way hospital systems nationwide are working to combat the opioid crisis, which kills more than 115 Americans through overdoses every day.

Still, hundreds of thousands of people who are desperate to quit lack the resources to get better.

"There just aren't enough facilities - detox or opioid treatment programs - or enough beds in this country for patients with addictions," says neurologist Joanna Katzman, director of the University of New Mexico Pain Center. "There aren't enough outpatient centers that have methadone or buprenorphine for long-term aftercare and not enough trained doctors who can actually help those who are severely addicted."
Taking Pills Off the Streets
Several hospitals have launched aggressive programs to curb opioid prescriptions and reduce the number of pills flooding the black market.

"Most people who misuse opioids start out by getting them from the medicine cabinet of someone they know," says Margaret Jarvis, a psychiatrist and chief of addiction medicine for Pennsylvania's Geisinger health system.

The region around Geisinger has an opioid death rate that eclipses New York City's. Over the past three years, the health system has rolled out several initiatives that have reduced opioid prescriptions from 60,000 to 31,000 per month. Pharmacists and addiction specialists are embedded at 15 primary care and specialty sites across the system to ensure safe and appropriate prescribing of painkillers and to monitor addiction risks among patients.

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"To prevent addiction, we write opioid prescriptions for a brief period - maybe for seven to 14 days, rather than a 30-day supply," says Gerard Greskovic, director of Geisinger's ambulatory clinical pharmacy programs. The goal, he says, is to get patients off of opioids as soon as possible.

Utah's Intermountain Healthcare, which spans 22 hospitals and 170 clinics, has set an ambitious goal to achieve by the end of 2018: Cut the number of opioid pills prescribed for acute conditions by 40 percent (5 million pills annually) at its hospitals and community clinics through tracking of prescriptions and providing patients with other pain management methods, such as physical therapy.

Similarly, UCHealth University of Colorado Hospital launched a one-click tool in 2017 that allows busy ER docs to instantly see how many prescriptions a patient has filled at other locations. In the past three years, the hospital has trimmed the number of opioid prescriptions from about 20 percent of patients to about 8 percent.

"Previously, it took three to five minutes and up to 35 clicks" to get into the system, versus about one second and one click now, says Jason Hoppe, an emergency medicine physician who helped integrate the statewide drug-monitoring program at UCHealth. (The program, used by most states, has been lauded by FDA Commissioner Scott Gottlieb.)
Treating the Youngest Casualties
Children's hospitals in hard-hit regions of the country - including Yale New Haven Children's Hospital, West Virginia's Cabell Huntington Hospital and East Tennessee Children's Hospital in Knoxville - have created special programs for babies born drug dependent to mothers who used opioids or other drugs during pregnancy. They suffer from neonatal abstinence syndrome, or NAS, which involves tremors, trouble sleeping and eating, and uncontrollable shaking and crying, among other problems. From 2004 to 2013, admission rates to U.S. neonatal intensive care units for NAS nearly quadrupled, and in 2012, nearly 22,000 babies were born drug dependent.

At the University of Vermont Medical Center in Burlington, the emphasis is on using medication to wean babies off of opioids, combined with parental bonding and empowerment. Parents are taught to administer methadone at home and receive ongoing support through follow-up calls and regular office visits.

As a partner organization in the CHARM Team (Children and Recovering Mothers) collaborative, UVM Medical Center treats parent and child using a multidisciplinary approach that includes the obstetrical team, social workers, public health nurses, and child and family services agencies. A major CHARM goal is to create a supportive atmosphere and relieve the stigma, shame and guilt that can prevent women from seeking help.

"Most of these mothers want to do whatever is best for their babies," says Anne Johnston, a neonatologist and director of UVM Medical Center's Neonatal Abstinence Clinic. "We try to give them appropriate support and treat them medically - and create a community of recovery, which is so important for long-lasting sobriety."

When Skyler Browder gave birth to Cree in 2014, he weighed 4 pounds, 14 ounces and required a two-week stay at UVM Medical Center's NICU. There, he was given tiny doses of methadone to wean him off the drugs he'd absorbed in the womb.

"I felt completely demoralized that I could potentially damage my child - I was a hot mess," Browder recalls. She was able to stay at the hospital for extended periods so she could bond with her baby, giving him the skin-to-skin contact that helped them both overcome their addictions.

"Cree and I got clean together," says Browder, who remains sober and is working to finish college.
Offering Comprehensive Care
Some hospitals provide a full continuum of care to smooth the path to recovery. At UCHealth University of Colorado Hospital in Aurora, that path starts in the emergency department, where, with the help of its one-click tool, staff can see a patient's history of pain medication prescriptions and determine if the individual is high risk. Should abuse be suspected, doctors can adjust their treatment plan accordingly, say by prescribing someone fewer pills and less often.

"We want to identify them before they switch to IV drug use," Hoppe says. "That's where they fall off the cliff."

Then, patients have several treatment options, based on their addiction severity. One is the Center for Dependency, Addiction and Rehabilitation, or CeDAR, the inpatient residential facility that treats adults and their families for up to 90 days and includes detox, therapy, 12-step groups and psychiatric care. Once in recovery, patients can transition to outpatient community programs that combine medication-based approaches with behavioral treatments to help them maintain sobriety.

Since receiving treatment, Blair Hubbard now works at UCHealth's CeDAR facility, counseling others.

Blair Hubbard needed intensive therapy to get clean after a 12-year opioid dependency. After having her wisdom teeth pulled as a high school senior, she was prescribed hydrocodone. She got hooked, eventually turning to OxyContin, then heroin. "I ran out of veins in my arms and started shooting up in my legs," Hubbard says.

After passing out from an infection caused by her IV drug use, she was hospitalized for 10 weeks. Hubbard had sepsis. Open-heart surgery was needed when one of her valves became badly infected. A bright spot? Hubbard's life-threatening emergency connected her to a medical team that helped her get treatment, housing and medical insurance.

"It was a blessing in disguise," says Hubbard, who still receives care for complications but has nonetheless earned her master's in professional counseling and is now a behavioral health specialist helping people in recovery at CeDAR. "I was desperate to kick - and sick of this lifestyle."
Tapping Telemedicine to Help Rural Communities
In rural New Mexico - as in so many pockets of the U.S. - patients in impoverished, isolated communities are cut off from addiction specialists. But through the Project ECHO Pain and Opioid Management program, the UNM Health System is connecting doctors in rural communities with its Albuquerque-based team of pain specialists. During weekly teleconferences, as many as 20 medical teams in remote regions can discuss patient cases with specialists in Albuquerque - and learn from each other's experiences through this hub-and-spoke model.

Say a primary care clinician from Sand Springs, Oklahoma, wants advice on how to switch a substance-abusing patient with multiple issues - severe facial pain, depression and post-traumatic stress disorder - from high-dose opioids to withdrawal-blocking Suboxone. The (hub) team in Albuquerque can offer guidance while (spoke) doctors in nearby Oklahoma can point the physician to local resources that may benefit the patient, according to Katzman.

Since its inception a decade ago, ECHO Pain has helped greatly reduce the rate of overdose deaths in New Mexico, which had been among the highest in the nation. It's been adopted by the Indian Health Service and more than two dozen institutions nationwide. The Veterans Health Administration, the Army and the Navy now have ECHO hubs, and in 2016, the U.S. Department of Health and Human Services earmarked $9 million in grants to improve opioid addiction treatment in rural counties in Oklahoma, Colorado and Pennsylvania using the ECHO model.

"Many local doctors don't have the time to keep up with what we know works for treating addiction," says Katzman, who launched ECHO Pain. "This model enables us to share evidence-based practices with them so everyone gets better care."
Adding Boot Camps for Pain Management
Many hospitals, including Stanford Health Care, Cleveland Clinic, Mayo Clinic and Johns Hopkins, have launched pain management boot camps that provide alternatives to painkillers for people suffering from chronic pain. These outpatient programs integrate traditional and complementary medicine techniques. The Mayo Clinic's intensive rehabilitation program, for instance, entails daily seven-hour sessions for three weeks.

Part of the treatment is the schedule," says Wesley Gilliam, clinical director of Mayo's Pain Rehabilitation Center. "Many of our participants have been struggling with their addictions for so long that they've lost track of time and their whole clock has been thrown off."

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Sessions include mindfulness meditation, yoga, cognitive behavioral therapy, physical and occupational therapy - even breathing exercises to ease the anxiety triggered by chronic pain.

Greg McLaughlin's experience was typical. After back surgery, the Minnesotan became reliant on pain pills and muscle relaxants. Because of a family history of addiction, he worried about his own risk.

"The medications and the pain changed me completely," he says. He became increasingly isolated, spending his days in physical agony, struggling with depression and anxiety.

When his doctor suggested Mayo's pain clinic, he was skeptical but willing. Slowly, he stopped taking his meds and began moving again, doing physical therapy and cardio exercises, and yoga and deep-breathing when he felt anxious.

"The tools I learned in rehab are an entirely different way of keeping the pain at bay," says McLaughlin, who no longer takes drugs. "Chronic pain is now a small part of my life, which is full of purpose and amazing people."
Excerpted from U.S. News' "Best Hospitals 2019," the definitive consumer guidebook to U.S. hospitals. Order your copy now.

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How Hospitals Are Joining the Battle Against Opioids

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It was 3 a.m., and he'd been driving all over in search of an addiction treatment center. Earlier that day in 2017, he'd been fired from his insurance job when his boss discovered he'd stolen $40, which he'd used to buy black-market prescription opioids.

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In Ohio, Signs of a Shifting Drug Crisis

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Psychostimulants such as meth were involved in 12 percent of unintentional overdose deaths in Ohio in 2017, researchers said.

Overdose deaths involving meth and other stimulants rose dramatically in the Buckeye State between 2010 and 2017, according to a recent data analysis that underscores the evolving nature of the nation's current drug crisis.

"We're seeing a new and dangerous trend here in Ohio that is also manifesting around the country," says Orman Hall, author of the analysis and an Ohio University executive in residence. "We have seen a plateau effect in 2017 in terms of total (drug) overdose deaths, but interestingly, what we are beginning to see is an uptick in the number of mentions for psychostimulants, which includes methamphetamine, and cocaine."

The number of unintentional overdose deaths involving psychostimulants - a category encompassing prescription drugs like Ritalin and Adderall as well as methamphetamine - grew exponentially in Ohio from nine deaths in 2010 to 509 in 2017, marking an increase of more than 5,000 percent. The analysis by the Ohio Alliance for Innovation in Population Health, a collaboration between Ohio University and the University of Toledo, also found that nearly 80 percent of unintentional overdose deaths involving a psychostimulant included an opioid as well, and that more than 70 percent involved the deadly synthetic opioid fentanyl.

Overall, psychostimulants were involved in 12 percent of unintentional overdose deaths in the state in 2017, researchers said.

Psychostimulants like methamphetamine were involved in nine unintentional overdose deaths in Ohio in 2010. That number rose to 509 in 2017, a more than 5,000 percent increase, according to data collected by the Ohio Alliance for Innovation in Population Health.

For the analysis, researchers examined death certificate data from the Ohio Department of Health and tabulated certain types of drugs found in people who died of an unintentional overdose, though no primary cause of death was noted in the data used.

The study also showed that the number of people who died of an unintentional overdose in Ohio and had cocaine in their system rose from 212 in 2010 to 1,520 in 2017, a year in which 32 percent of all unintentional overdose deaths in the state involved cocaine in some amount.

Similar to psychostimulants, more than 80 percent of cocaine-involved overdose deaths in 2017 also involved an opioid.

"I think that the number of overdose deaths specifically attributed to opioids has been such an overwhelming problem that it has distracted us from potential trends in the data, and clearly, methamphetamines and cocaine are on the rise," Hall says.

At a more local level, Wayne County, at 17.2 percent, experienced the highest percentage of unintentional overdose deaths involving a psychostimulant over the time period analyzed. Pike County, at 14.5 percent, and Wyandot County, at 14.3 percent, had the second- and third-highest rates in Ohio, respectively.

"Looking at the data, most of the counties that are in dark blue on the psychostimulant map are rural, with the exception of Butler County, so the vast majority are rural and they're predominantly white," Hall says. "Methamphetamine appears to be more available in Appalachia and other rural counties."

Dennis Lowe, commander of a multijurisdictional law enforcement task force that serves Ohio's Athens, Fairfield and Hocking counties, says the results echo what he and his colleagues have seen on the ground in recent years.

"We've really seen a shift in our work from opiates to methamphetamine in our population," Lowe says. "Now, that's not to say that opioids aren't still being used, because we see that they are and we certainly still see overdoses and overdose death. But ... opiate use and trafficking has really gone underground."

Lowe says a transition from meth produced in domestic, homemade labs to a purer, cheaper product pushed by Mexican cartels into the local market occurred between 2015 and 2017. Officers can buy a gram of methamphetamine that once cost $100 or more for between $25 to $40 today, Lowe says.

And with a surge of legislation aimed at curbing the opioid crisis and providing treatment for those addicted to opioids, Lowe says the resources available to address other drugs proliferating in the market are limited.

"Law enforcement and first responders across the country, I think we're all really dealing with this meth problem," Lowe says. "There's a ton of money coming down from the federal government that's directed toward opiates and the opiate response, and at the local level we really have moved on to methamphetamines. In some cases, those dollars are tied to specific opiate issues, so we can't use those same dollars for treatment and rehab and prevention programs, or even enforcement efforts, on methamphetamine."

"This is not necessarily a new trend, but I think from the standpoint of public health policy, it's something that we have largely missed because of our preoccupation with opioids, which is obviously causing more carnage from a death standpoint, and will continue to do that for some time," he says.

Katelyn Newman , Staff Writer

Katelyn Newman is a staff writer for the Healthiest Communities division at U.S. News & World R...Katelyn Newman is a staff writer for the Healthiest Communities division at U.S. News & World Report. You can follow her on Read more Twitter or reach her at knewman[at]usnews.com.

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In Ohio, Signs of a Shifting Drug Crisis

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Psychostimulants such as meth were involved in 12 percent of unintentional overdose deaths in Ohio in 2017, researchers said. Overdose deaths involving meth and other stimulants rose dramatically in the Buckeye State between 2010 and 2017, according to a recent data analysis that underscores the evolving nature of the nation's current drug crisis.

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Maine Directs Much of Emergency Opioid Money to Treatment

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Maine Directs Much of Emergency Opioid Money to Treatment

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14 current event

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By MARINA VILLENEUVE, Associated Press

PORTLAND, Maine (AP) - Maine has directed most of the first wave of federal emergency money to target the opioid crisis on treatment, according to an Associated Press analysis, similar to other states that have not expanded Medicaid.

States are taking very different approaches to spending their initial allotments under the 21st Century Cures Act grant program, according to data the AP obtained through a federal Freedom of Information Act request. Seven states that expanded Medicaid under President Obama's health overhaul directed less to treatment than non-expansion states, partly because the insurance program already covers addiction treatment.

Maine lawmakers passed Medicaid expansion five times, but Republican Gov. Paul LePage vetoed each effort. Maine voters voted to expand Medicaid last fall, but the governor has blocked it over his fiscal concerns.

Maine was awarded $1.4 million, and spent about $585,000, on treatment and prevention from May 2017 through April 2018. Maine spent no funds on recovery or administration.

The emergency money from Congress was part of a two-year, nearly $1 billion grant program. It was distributed according to a formula favoring states with more overdose deaths and treatment needs.

Maine ranked fourth among states for how much it allocated of its overall grant to treatment services: 81.9 percent. Meanwhile, the state ranked eighth for opioid overdoses, with 301 deaths in 2016.

Malory Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services in Maine, said it was "misguided" for Maine to have refused to expand Medicaid and in doing so, decline federal matching dollars for expanded drug treatment services.

"These dollars could have been used for recovery efforts and ancillary services in recovery that folks are looking at across the country," she said.

For example, Maine could have spent money to provide housing and transportation help for individuals in recovery, said Shaughnessy, whose group represents community behavioral health organizations across the state.

Maine plans to spend $1.2 million on opioid treatment services provided by seven Maine providers, according to the AP's figures. The state also plans to direct about $238,000 on prevention efforts led by the University of New England and Rinck Advertising and $26,000 on recovery services provided by Healthy Acadia, which has offices in Ellsworth and Machias.

Emily Spencer, spokeswoman for Maine's Department of Health and Human Services, said Maine directed Cures Act funding toward medication-assisted treatment in areas of the state with the greatest need. She noted that treatment efforts tend to cost more than recovery services, which she says Republican Gov. Paul LePage's administration is expanding through peer-led centers, recovery coaches and "navigator services."

"The state also utilized these funds to implement programs for individuals in need of a higher level of care, offering daily in-person doses of buprenorphine targeting agency waitlists and the homeless," she stated. "Additionally, Maine used the available funds for recovery coaching services, as well as prevention-focused activities such as social media campaigns and community-based strategies."

Thirty-three states have expanded Medicaid, receiving enhanced federal funding to cover poor adults. Historically, Medicaid has covered a large share of all addiction treatment in the U.S., more than all private insurance combined. Medicaid covers 4 out of 10 adults under age 65 with opioid addiction.

Last fall, nearly six out of ten Mainers voted to expand Medicaid, but the referendum lacked a funding mechanism for the state's share. A legal and political battle over implementation has ensured.

The governor vetoed a funding bill using budgetary surplus and tobacco settlement dollars, and suggests the next governor instead raise taxes on hospitals. Meanwhile, his administration has issued at least 3,500 denial letters to Mainers seeking Medicaid coverage under expansion, which was estimated to help 70,000 to 80,000 Mainers.

Expansion states spent $1,581 per patient for treatment, the AP found. States that did not expand Medicaid spent $2,645 per patient on opioid addiction treatment on average, while Maine spent $721 on average per each of 604 patients.

Copyright 2018 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Tags: Maine, opioids, drugs, prescription drugs, money, funds, state budgets, Medicaid, addiction, health insurance

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Maine Directs Much of Emergency Opioid Money to Treatment

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By MARINA VILLENEUVE, Associated Press PORTLAND, Maine (AP) - Maine has directed most of the first wave of federal emergency money to target the opioid crisis on treatment, according to an Associated Press analysis, similar to other states that have not expanded Medicaid.

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Cocaine Cut With Anti-Worming Drug May Cause Brain Damage

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Cocaine Cut With Anti-Worming Drug May Cause Brain Damage

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Common or street names: peyote, buttons, cactus, mescaline, mesc, peyoto

What is mescaline?

Mescaline is a psychedelic hallucinogen obtained from the small, spineless cactus Peyote ( Lophophora williamsi), the San Pedro cactus, Peruvian torch cactus, and other mescaline-containing cacti. It is also found in certain members of the Fabaceae (bean family) and is produced synthetically.

People have used hallucinogens for hundreds of year, mostly for religious rituals or ceremonies. From the earliest recorded time, peyote has been used by natives in northern Mexico and the southwestern United States as a part of traditional religious rites. Mescaline leads to rich visual hallucinations which were important to the native peyote cults. It has an effect that is similar to LSD or psilocybin (magic mushrooms), other hallucinogenic drugs.

The top of the cactus above ground, or the crown, consists of disc-shaped buttons that are cut from the roots and dried. These buttons are generally chewed or soaked in water to produce an intoxicating tea. It can be consumed raw or dried but is extremely bitter. The hallucinogen may also be ground into powder for oral capsules, or smoked with marijuana and tobacco. The hallucinogenic dose is about 0.3 to 0.5 grams (equivalent to about 5 grams of dried peyote) and lasts about 12 hours. However, different doses can affect people in various ways, and doses extracted from plants can vary widely.

Mescaline is used primarily as a recreational drug and is also used to supplement various types of meditation and psychedelic therapy. It is classified as a schedule I drug in the U.S., making it illegal in all forms (including peyote); however, it remains legal in certain religious ceremonies registered by the Native American Church 1,2, 3 Schedule I drugs have a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision.

Use and effects

"Trips" for the users may be pleasurable and enlightening or anxiety-producing and unpleasant (known as a "bad trip"). There is no way to know how a user's experience may ultimately play out. Common effects after use may include:

visual hallucinations and radically altered states of consciousness (psychedelic experience)

open and closed eye visualizations

euphoria

dream-like state

slowed passage of time

laughter

a mixing of senses (synesthesia, such as "seeing a sound" or "hearing colors")

pupil dilation

Side effects or risks

Side effects or risks of mescaline use may include:

anxiety, fear

racing heart beat (tachycardia)

dizziness

weakness

diarrhea

excessive sweating

tremors

nausea, vomiting

headache

accidental injury

psychosis, panic or paranoia

seizures

amnesia (loss of memory)

posthallucinogen perceptual disorder (flashbacks)

rarely, suicidal thoughts or actions

Like most psychedelic hallucinogens, mescaline is not physically addictive; however, it can cause tolerance meaning higher doses are need to achieve the same hallucinogenic effect. Mescaline-containing cacti can induce severe vomiting and nausea, which is an important part to traditional Native-American or Shaman ceremonies and is considered a cleansing ritual and a spiritual aid.

If you take prescription medications, there are no well-controlled studies to determine the overall effect of drug interactions. Medications that have an effect in the brain and may affect serotonin levels (for example: antidepressants, antipsychotic agents, medications for bipolar disorder) may have the potential for dangerous drug interactions when combined with mescaline. Drugs that affect the circulatory system, heart, or have stimulant affects may lead to rapid pulse and dangerous outcomes. Other drug interactions are also possible, although scientific data are limited.

Use in Pregnancy

According to the National Institute of Drug Abuse (NIDA), researchers have found that mescaline found in peyote may affect the fetus of a pregnant woman using the drug. ⁵

Treatment

There are no FDA-approved medications to treat abuse of mescaline or other hallucinogenic drugs. Research needs to be completed to evaluate the effects of behavioral therapies for these substances. ⁴

Related:

See Also

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Mescaline (hallucinogen) Uses, Effects & Hazards - Drugs.com

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Common or street names: peyote, buttons, cactus, mescaline, mesc, peyoto Mescaline is a psychedelic hallucinogen obtained from the small, spineless cactus Peyote ( Lophophora williamsi), the San Pedro cactus, Peruvian torch cactus, and other mescaline-containing cacti. It is also found in certain members of the Fabaceae (bean family) and is produced synthetically.

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Current Event 11

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What 3 Nurses In Ohio Taught Us About the Opioid Crisis

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The opioid crisis isn't just affecting drug abusers and their families. Nurses and other frontline healthcare workers are now also in danger. Learn the symptoms

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By

The U.S. Food and Drug Administration approved a powerful new opioid medication on Friday, in spite of major concerns raised by health advocates that the drug's strength and design could prove harmful for patients and the public.

The product, Dsuvia, consists of the synthetic opioid sufentanil, which is 500 times stronger than morphine, packaged in a plastic applicator for faster pain relief.

Critics, including the head of the FDA advisory committee that reviews pain-relieving products, are worried about putting such a potent and addictive medication on the market in the midst of the U.S.'s opioid crisis.

But Dsuvia's manufacturer, the drugmaker AcelRx Pharmaceuticals Inc. , said that the opioid was dose-adjusted to be no stronger than any other already-available one, and would help medics relieve pain on the battlefield.

See more: As powerful new opioid nears FDA approval, critics ask if U.S. is stoking its drug crisis

The FDA, though it acknowledged the outcry, ultimately took the latter view, approving Dsuvia on Friday. AcelRx shares surged 15.7% to $4.80 that day, and rose 3.3% in Monday premarket trade.

Military uses for the drug were an important consideration, Commissioner Scott Gottlieb noted in a statement, and there are "very tight restrictions being placed on the distribution and use of this product." But questions about new opioids were warranted, he said, and FDA staff will now look at a new framework for opioid approvals.

"We won't sidestep what I believe is the real underlying source of discontent among the critics of this approval - the question of whether or not America needs another powerful opioid while in the throes of a massive crisis of addiction," he said.

"We owe an answer to those who support us in these decisions, and to those who may disagree. We owe an answer to patients with medical pain, and the innovators who take risks to develop products to help address their needs. We owe it to Americans who want the FDA to do our part to help end one of the biggest addiction crises of modern times, while we carefully balance these grave risks against patient needs."

Related: As opioid crisis raged, Insys pushed higher doses of addictive drug and pushed salespeople to 'own' doctors

AcelRx

AcelRx's opioid product Dsuvia consists of a tablet of the potent opioid sufentanil, which the company says is dose-adjusted so it no stronger than any other opioid already available in the U.S.

Outspoken critics like the consumer advocacy group Public Citizen and the FDA advisory committee chair, Dr. Raeford Brown, meanwhile, said they were disappointed with the FDA decision.

Brown, a professor of anesthesiology and pediatrics at the University of Kentucky, chairs the FDA's Anesthetic and Analgesic Drug Products Advisory Committee.

That committee voted in favor of Dsuvia's approval in mid-October, without Brown there. He was instead at a major anesthesiology conference, which Brown says he had told the FDA about, yet the regulator did not move the advisory committee meeting.

Read: Opioids are ravaging the U.S., but they're still the best pain drug we've got

The FDA previously failed to approve Dsuvia in 2017 and, "the lack of efficacy data and the sponsor's inadequate response to safety concerns have not been addressed" since then, Brown said in a statement.

"Clearly the issue of the safety of the public is not important to the commissioner, despite his attempts to obfuscate and misdirect," Brown said. "I will continue to hold the agency accountable for their response to the worst public health problem since the 1918 influenza epidemic."

AcelRx shares have surged 71% over the last three months, compared with a 4% decline in the S&P 500 and a 0.8% decline in the Dow Jones Industrial Average

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Powerful new opioid 500 times stronger than morphine approved in U.S. in spite of outcry

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Critics worried about putting such a potent and addictive medication on the market in the midst of the U.S.'s opioid crisis.

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A majority of lawmakers in the Delaware House of Representatives have voted in favor of legislation to legalize marijuana possession and sales but, because of procedural rules requiring supermajority support, it did not advance.

The proposal, which received 21 yes votes to 15 no votes (with 5 members not voting) would have allowed adults over 21 years of age to legally possess up to one ounce of marijuana as well as five grams of cannabis concentrates. A system of regulated and taxed marijuana production and sales would also have been authorized, but home cultivation was not included in the proposal.

The legislation's sponsor, Rep. Helene Keeley (D), moved to amend the bill from its initial draft in an attempt to garner backing from more colleagues.

Because the legislation contains provisions dealing with taxes and fees, it needed the support of at least 60% of House lawmakers to advance under the General Assembly's rules. It fell four votes short of that requirement.

Even if the bill had cleared the House, its fate in the Senate before Saturday's end-of-session legislative deadline was uncertain. And even if it passed there, Gov. John Carney (D) has said he's not yet ready to support legalization, though it is not clear if he would have gone so far as to veto the lawmaker-approved bill if it arrived on his desk.

Despite the formal loss, the legislative action is one of only a handful of times in history that a marijuana legalization bill received majority support on the floor of a state legislative body in the U.S.

Earlier this year, Vermont lawmakers approved a bill to legalize low-level cannabis possession and home cultivation. The proposal was signed into law by Gov. Phil Scott (R) and goes into effect this weekend.

New Hampshire's House of Representatives also approved a marijuana legalization bill this year, but it did not advance further in the legislative process.

The development in Delaware comes one day after voters in Oklahoma overwhelmingly approved a ballot measure to legalize medical cannabis.

Voters in several other states are expected to consider marijuana ballot measures during the November general election.

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Majority Of Delaware Lawmakers Approve Marijuana Legalization Bill, But It Fails

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A majority of Delaware House members voted to pass legislation that would have made the state the next to legalize cannabis, but it did not get the supermajority support needed to advance to the Senate.

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The China White drug is a synthetic version of furanyl fentanyl. China White became a substitute for heroin derived from fentanyl, an opioid prescription drug that can be ingested, injected or inhaled. Other street names of heroin cut with fentanyl include White China Drug, China Girl, and China Town.

A war against illegal drugs and their synthetic variants

Our country is currently engaged in a life-and-death struggle against alcohol and drug addiction. A major factor in the drug war is the onslaught of new designer synthetic drugs. These drugs are constantly flooding the market and increasing overdose deaths. According to Centers for Disease Control (), drug overdoses killed 63,632 Americans in 2016. Nearly two-thirds of these deaths (66%) involved a prescription or illicit opioid. Overdose deaths increased in all categories of drugs examined for men and women, people aged 15 and older, all races and ethnicities, and across all levels of urbanization.

Why synthetic drugs exist

Manufacturing and distributing scheduled drugs can have huge legal implications. For a first-time offense of a Schedule I and II drug, a person could face five to forty years in jail in addition to hefty fines. Heroin and cocaine are illegal drugs, and law enforcement is cracking down on drug trafficking to get them off the street. This is causing drug traffickers and manufacturers to produce drugs that are easier to make and sell, with less legal implications. Their solution to the problem - synthetic drugs.

What are synthetic drugs?

To quote the dictionary, synthetic is defined as; (of a substance) made by chemical synthesis, especially to imitate a natural product. Synthetic drugs are created to imitate and mirror the 'highs" or effects of narcotics, prescription drugs and even some everyday domestic products. Here is where designer drugs come in.

Different forms of designer drugs:

With the rise in opiate addiction sweeping the country, there is a growing demand for substitutes for controlled substances and known illegal drugs. One such alternate to heroin is furanyl fentanyl, a synthetic opioid. Fentanyl works like an opioid receptor, feeding the brain dopamine, and creates an intense high or euphoria. It also decreases breathing and slows heart rate. Fentanyl can be over 100 times as potent as heroin and morphine.

China White Drug - a deadly killer

China White has caused its own increase of drug overdose deaths with multiple variations of the illicit drug being made and sold on the streets. Illegal drug manufacturers dabble and play with the ingredients, preying on recreational users and heroin addicts. Users really have no idea what they are injecting or ingesting. There is no way to know the exact effect a synthetic drug can have on a person since the chemicals constantly change and vary in toxicity. Since the chemicals in any synthetic drug constantly change and vary in toxicity, there is no way to know its exact effect on a person. That makes it impossible to estimate how China White may impact an addict, increasing the chance of a fentanyl overdose.

Fentanyl is so deadly that contact with the drug in any form can be dangerous. An anti-overdose medication called Narcan was developed for law enforcement and medical practitioners to use. However, because of the varying ingredients used in designer drugs like China White, it is difficult for medical professionals and law enforcement to research and treat them effectively.

Opioids, heroin, and synthetic drugs like China White send euphoric messages to the reward center of the brain, increasing the chance of cravings and leading to an uncontrollable often unwanted drug addiction. This is what drug dealers prey on. In most cases when people try illicit drugs, they are not looking to become addicted. They are simply looking to continue the "happy high." Unfortunately, the cravings for the substance become a necessity - just like air and water is needed for survival. After a while, the body starts to rely on drugs to stimulate the dopamine release, creating a vicious cycle that is hard to break without outside professional help. Recovery is possible.

China White Drug withdrawal symptoms

The withdrawal from China White is often more severe than heroin. With muscle aches, chills, sweating, loss of appetite, rapid breathing to decreased breathing, confusion, and extreme mood changes that can last several days, it can be hard for a person to stop cold-turkey. A medically-managed detox with physical and mental support is recommended to prevent relapse for anyone fighting China White addiction.

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What is the China White Drug? | Serenity Acres

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China White is a synthetic version of furanyl fentanyl. It is a substitute for heroin derived from Fentanyl, an opioid prescription drug that can be ingested, injected or inhaled with deadly consequences.

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Current Event 13

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Ketamine, categorized as a "dissociative anesthetic," is used in powdered or liquid form as an anesthetic, usually on animals. It can be injected, consumed in drinks, snorted, or added to joints or cigarettes. Ketamine was placed on the list of controlled substances in the US in 1999.

Short- and long-term effects include increased heart rate and blood pressure, nausea, vomiting, numbness, depression, amnesia, hallucinations and potentially fatal respiratory problems. Ketamine users can also develop cravings for the drug. At high doses, users experience an effect referred to as "K-Hole," an "out of body" or "near-death" experience.

Due to the detached, dreamlike state it creates, where the user finds it difficult to move, ketamine has been used as a "date-rape" drug.

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What is Ketamine? Street Names & Side Effects - Addiction & Abuse - Drug-Free World

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Ketamine, categorized as a "dissociative anesthetic," is used in powdered or liquid form as an anesthetic, usually on animals. It can be injected, consumed in drinks, snorted, or added to joints or cigarettes. Ketamine was placed on the list of controlled substances in the US in 1999.

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1. Effects of Peyote on the Brain

2. Effects of Peyote on the Body

3. How Long Do Peyote Effects Last?

4. How Many People Use Peyote?

Peyote (or mescaline) belongs to a class of drugs known as hallucinogens.

Mescaline is the active hallucinogenic ingredient in peyote, which is a small, spineless cactus ¹. The top, or crown, of the peyote cactus has circular-shaped buttons that are cut off and ingested in a variety of ways, such as by chewing them, soaking them in water to produce a psychoactive liquid, grinding them into a fine powder that can be swallowed in capsules, or smoking them with marijuana or tobacco ¹. Mescaline can be synthetically derived as well ¹. Common street names for peyote or mescaline include "cactus," "mesc," "peyote," and "buttons" 1,2.

Peyote has long been used in religious rituals to connect users with a spiritual entity or deity by detaching them from reality and inducing visions ³. Current users of peyote may do so in a more social or recreational manner, using mescaline to relax, enjoy themselves, or achieve enlightenment ³.

In the United States, peyote and mescaline are listed by the Drug Enforcement Administration (DEA) as Schedule I drugs, meaning they have no currently accepted medical use, a high potential for abuse, and are considered unsafe for use, even under medical supervision ¹.

Effects of Peyote on the Brain

Persistent Psychosis

The long-term effects of peyote on the brain are not well-known and are generally rare; however, chronic users may experience persistent psychosis or a condition known as Hallucinogen Persisting Perception Disorder (HPPD) 2,6.

Persistent psychosis is an ongoing series of psychological symptoms, including mood swings, visual disturbances, paranoia, and disorganized thoughts ².

HPPD occurs after hallucinogen use has stopped, and involves the continued re-experiencing of peyote effects, such as hallucinations, flashes of color, more intense colors, or trails of images around objects in motion ⁶. These symptoms can cause significant impairment and distress in a user's life, interfering with functioning at work, school, or in social settings ⁶.

Peyote has various short-term effects on the brain, similar to the effects of other hallucinogenic drugs, such as LSD or psilocybin ("magic mushrooms") ¹. Peyote is thought to elicit its effects by disrupting neurotransmitter transmission in the parts of the brain that affect mood, thought, and perception 2,4. These effects on the brain can include 1,2:

Altered body image or sense of self.

Altered perception of time and space.

Euphoria.

Feelings of anxiety or panic.

Feeling relaxed or detached from surroundings.

Hallucinations, which can affect any of the senses - visual, auditory, etc.

Illusions.

Increased intensity of emotions and sensations.

Mood swings ⁵.

Paranoia.

Spiritual experiences.

Synesthesia, or a mix-up of senses, such as hearing colors or seeing sounds.

Temporary psychosis.

Drug use often precipitates the development of tolerance, where the brain becomes desensitized to the effects of the drug. This leads to the person requiring more of the drug to attain the desired effects. There is some evidence that hallucinogens, such as peyote, can produce tolerance ². Another phenomenon, known as cross-tolerance, occurs with many hallucinogenic drugs ². Taking specific hallucinogens can increase one's tolerance to different, chemically-similar hallucinogens, such as LSD, mushrooms, and peyote since they work on the same areas of the brain ².

Who Answers?

Effects of Peyote on the Body

Peyote also has a strong effect on the body, similar to other hallucinogenic drugs. These physical effects may include 1,2,4:

Dilated pupils.

Dry mouth.

Flushed skin.

Increase in body temperature, which can lead to excessive sweating.

Headaches.

Increased energy levels.

Increase heart rate.

Increased blood pressure.

Muscle weakness.

Impaired motor skills and coordination.

Loss of appetite.

Nausea or vomiting.

Sleep difficulties.

The long-term effects of peyote use on the body are not well-known and require more research. This drug should never be used during pregnancy, as peyote has been linked to abnormalities in developing fetuses ⁴.

How Long Do Peyote Effects Last?

Peyote, like many other hallucinogens, is a relatively long-acting drug. The effects of peyote can start to be felt between 20 to 90 minutes after ingestion, and can last for up to 12 hours 2,4. Ingesting peyote is known as a "trip," and the overall experience can be highly unpredictable.

The experience and intensity of peyote's effects are highly impacted by various factors, including the amount of peyote consumed, as well as the user's ⁴:

Mood.

Personality.

Surroundings.

Expectations of peyote trip.

A good trip can provide enjoyable sensations, mental stimulation, and a feeling of heightened insight, while a "bad trip" can cause horrifying thoughts and emotions, such as anxiety, despair, or fear of loss of control, madness, or death ⁴.

How Many People Use Peyote?

While substance use in America is monitored through the use of regular surveys, hallucinogens are studied as a class, making it somewhat difficult to tease out data specific to the substance. The category of hallucinogens includes LSD, PCP, peyote, mescaline, psilocybin mushrooms, and MDMA ⁷.

The following 2014 statistics associated with hallucinogen use were reported ⁷:

Approximately 1.2 million Americans aged 12 or older reported current use of hallucinogens.

322,000 more men than women reported past month hallucinogen use.

More than 930,000 people aged 12 or older tried hallucinogens for the first time.

About 136,000 Americans between the ages of 12 and 17 reported using hallucinogens.

About 502,000 Americans between the ages of 18 and 25 were current hallucinogen users.

An estimated 535,000 Americans aged 26 or older reported current hallucinogen use.

References:

1. Drug Enforcement Administration. (2015). Peyote and mescaline.

2. National Institute on Drug Abuse. (2016). DrugFacts: Hallucinogens.

3. National Institute on Drug Abuse. (2015). Why Do People Take Hallucinogenic or Dissociative Drugs?

4. National Institute on Drug Abuse. (2015). How Do Hallucinogens (LSD, Psilocybin, Peyote, DMT, and Ayahuasca) Affect the Brain and Body?

5. National Institute on Drug Abuse. (2015). Hallucinogens and dissociative drugs.

6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

7. Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: results from the 2014 national survey on drug use and health. HHS Publication No. SMA 15-4927, NSDUH Series H-50.

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Peyote, or mescaline, belongs to the class of hallucinogens. Learn the effects it has on the mind and body and how long they last.

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CLOSE

Weed is legal in some states and winked at in others. Yet it's the reason an undocumented Iowa youth is in jail and could be sent to Mexico.

The pungent scent and smoke of weed mingled with that of jerk chicken on the grill in Brooklyn's Crown Heights on Labor Day during New York's annual Caribbean Carnival Parade. As steel bands and reggae music played from floats, a man worked a sidewalk hawking small clumps of marijuana from a Styrofoam take-out box.

While savoring the festivities, I was grappling with a paradox. New York is not one of the nine U.S. states (including the District of Columbia) to have legalized recreational marijuana use. But if the many police officers there noticed its presence, they weren't bothered.

Back in Des Moines, a 19-year-old has been in jail for five months after being caught with a lump of pot of about one gram - about the size of two bottle caps -- and now faces deportation to Mexico for it.

More: Hope for some 'dreamers' despite Trump move to end DACA

More: 'Dreamer': DACA changed everything for me. Removing it would be a mistake.

This is where the politics of marijuana meets the debate over the Deferred Action for Childhood Arrivals (DACA) program. That's the Obama-era policy of granting temporary legal status for immigrants who were brought here as children by their parents, if they apply and meet age and other criteria. But President Trump announced last week he would end the program unless Congress acts.

Luis Quintana Alvarez, who came to the U.S. with his mother and siblings at 11 months old, was granted DACA status. Then a year ago, he was riding in a car to Ames with his cousin when they were stopped for speeding. Police found a gram of marijuana (worth about $10, according to online testimonials) in the car.

Quintana and his attorney, Ta-Yu Yang, say he claimed the pot was his to protect his cousin, a U.S. citizen, from getting kicked out of college. Quintana, who had just turned 18, thought he'd get off easier because of his age.

The pot charge itself resulted in a year of probation, but triggered federal involvement because of his DACA status. That was revoked; he was slated for deportation and denied bail.

Quintana appealed, arguing a gram of marijuana is not a serious controlled-substance crime as defined by immigration law. People are ineligible for DACA if they've been convicted of a felony, significant misdemeanor or multiple misdemeanors. But Yang says the Immigration and Naturalization Act makes an exception for possession of 30 grams or less of marijuana.

But the appeal was rejected. Yang then filed for asylum on Quintana's behalf, which requires convincing a judge someone would face persecution in the homeland because of race, religion, nationality, political opinions or membership in a particular social group. Quintana's claim is based on a novel argument: that having been a DACA recipient would make him a target for violence and exploitation in Mexico.

Quintana says it would identify him as someone who had residence and family ties in the United States because Mexican cartels are known to target people with U.S. ties for kidnap and ransom demands. Yang says there's not yet a record of that happening because DACA kids have not been deported.

But an immigration judge in Omaha late last month rejected that claim, ruling that DACA doesn't qualify as a social group.

Last October another Mexican national, Constantino Morales, was deported from Des Moines and shot to death by a cartel in Mexico.

Quintana is American by all obvious measures except his passport. If deported to Mexico, "My world would just be over," he said by phone from the jail Thursday. "...I would feel like a foreigner because I've been here in America all my life. I pledged allegiance from kindergarten to 12th grade."

Despite his ruling, the judge found Quintana "sincere, responsive and forthright." Also testifying for him were his mother, twin brother and sister (both students at Iowa State University), and a friend.

His mother, who works as a housekeeper and asked not to be identified, told me she is so anxious and depressed about his arrest she is barely able to function. Speaking through an interpreter, she said Quintana was the victim of physical and sexual abuse by his father, and that left him with anxiety and insecurities. The father also abused her and the other children, she said. He left when Quintana was 3 and hasn't been heard from since.

Quintana said he still suffers emotionally from the abuse. His mother sent him for counseling when he was younger, "but I never opened up to any counselor. I just had so many walls built up." He said he had fallen in with a bad crowd but isn't friends with them anymore. He has long dreamed of playing professional soccer but lately has also been considering law.

More: Marijuana devastated Colorado, don't legalize it nationally

More: DACA: I'm undocumented and I am part of what makes America great.
POLICING THE USA: A look at race, justice, media
Yang is appealing the latest denial to the Board of Immigration Appeals.

Quintana said he has seen people bond out despite much more serious crimes or long criminal histories. "I really don't understand how they could want to deport me, who has been here all his life, over a small amount of marijuana," he said.

There is no good explanation, other than that he's a casualty of immigration politics. Congress needs to pass immigration reform. Meanwhile, let's hope the next judge shows independent judgment, recognizes Luis Alvarez Quintana has been through enough, and gives him the chance to build a life free from fear in the place he has always known as home.

Rekha Basu is a columnist for The Des Moines Register, where this piece first appeared. Follow her on Twitter @RekhaBasu

Read or Share this story: https://usat.ly/2xZ8Vry

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DACA teen faces deportation because our immigration and marijuana policies are crazy

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Weed is legal in some states and winked at in others. Yet an undocumented Iowa youth is in jail and could be sent to Mexico over one gram.

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FDA approves opioid painkiller 1,000 times stronger than morphine

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A new opioid tablet that is 1,000 times more potent than morphine and 10 times stronger than fentanyl was approved by the Food and Drug Administration Friday as a fast-acting alternative to IV painkillers used in hospitals.

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Is it the Right Choice to Reclassified ?

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from research organizations
Credit: © aquatarkus / Fotolia
In an evaluation of the safety and abuse research on the drug in hallucinogenic mushrooms, Johns Hopkins researchers suggest that if it clears phase III clinical trials, psilocybin should be re-categorized from a schedule I drug -- one with no known medical potential -- to a schedule IV drug such as prescription sleep aids, but with tighter control.

The researchers summarize their analysis in the October print issue of Neuropharmacology.

"We want to initiate the conversation now as to how to classify psilocybin to facilitate its path to the clinic and minimize logistical hurdles in the future," says Matthew W. Johnson, Ph.D., associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. "We expect these final clearance trials to take place in the next five years or so."

Following the Controlled Substances Act of 1970, any drug with the potential for abuse is categorized based on criteria that take into account whether the drug has accepted medical use, and its safety and the potential for abuse. Although preliminary research studies suggest that psilocybin may be effective for smoking cessation and for disorders such as cancer-specific depression and anxiety, it must clear phase III clinical trials before the Food and Drug Administration can be petitioned to reclassify it.

Studies in animals and humans both show low potential for abuse, the researchers say. When rats push a lever to receive psilocybin, they don't keep pushing the lever like they do for drugs such as cocaine, alcohol or heroin. When it comes to human studies, people who have used psilocybin typically report using it a few times across their lifetime.

As for safety, studies show it frequently falls at the end of the scales with the least harm to users and society, say the researchers. Psilocybin also is lowest in the potential for lethal overdose as there is no known overdose level.

"We should be clear that psilocybin is not without risks of harm, which are greater in recreational than medical settings, but relatively speaking, looking at other drugs both legal and illegal, it comes off as being the least harmful in different surveys and across different countries," says Johnson.

That being said, although psilocybin is relatively less harmful than other drugs and not prone to compulsive abuse, the researchers don't recommend releasing psilocybin into patients' hands even with a prescription. "We believe that the conditions should be tightly controlled and that when taken for a clinical reason, it should be administered in a health care setting monitored by a person trained for that situation," says Johnson. The researchers foresee that the process for psilocybin use in the clinic would be similar to how an anesthesiologist prescribes and administers a drug, minimizing the potential for abuse or harm.

Journal Reference:

Matthew W. Johnson, Roland R. Griffiths, Peter S. Hendricks, Jack E. Henningfield. The abuse potential of medical psilocybin according to the 8 factors of the Controlled Substances Act. Neuropharmacology, 2018; DOI: 10.1016/j.neuropharm.2018.05.012

Cite This Page:

Below are relevant articles that may interest you. ScienceDaily shares links with scholarly publications in the TrendMD network and earns revenue from third-party advertisers, where indicated.

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controlled substances; pharmaceuticals; pharmacology; psychedelic drugs; addiction; illegal drugs; biotechnology; bacteria; wild animals; public health; scientific conduct; poverty and learning

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Reclassification recommendations for drug in 'magic mushrooms': If phase III clinical trials are successful, researchers suggest categorizing the drug as schedule IV

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In an evaluation of the safety and abuse research on the drug in hallucinogenic mushrooms, researchers suggest that if it clears phase III clinical trials, psilocybin should be re-categorized from a schedule I drug -- one with no known medical potential -- to a schedule IV drug such as prescription sleep aids, but with tighter control.

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Alcohol Demand & Impact on Retail Market

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If you live in an urban area of the US, the number of alcohol outlets in your neighborhood is probably not related to your or your neighbors' alcohol use. Although greater numbers of outlets have been related to more alcohol use and related problems, in recent studies it has also been shown that more outlets open in neighborhoods surrounded by areas where the demand for alcohol is greatest. Outlets typically open in low-income neighborhoods located near areas with high-income populations. Until this study, we did not know whether two key correlates of alcohol demand -- income and population size -- had long-term causal effects on the growth of number of outlets over time. In this study we show that income and population size have long-term multi-year effects on the growth of alcohol markets in neighborhood areas.

This new study conducted at the Prevention Research Center (PRC) of the Pacific Institute for Research and Evaluation in cooperation with researchers at Emory University, Rollins School of Public Health, Department of Biostatistics, looked at the determinants of the number of licensed bars, restaurants, and liquor stores across neighborhoods in 53 California cities from 2000 to 2013.

We found that growth of new bars and pubs was greater in lower income areas adjacent to areas with larger populations and higher incomes; that is, near to neighborhoods that show greater demand for alcohol. Showing that growth in the numbers of these outlets over time is affected by neighborhood conditions related to alcohol demand, we provide evidence of the direct causal effects of demand for alcohol on the development of alcohol markets in urban areas.

Study author, Paul J. Gruenewald, says that these processes lead greater numbers of alcohol outlets and problems to concentrate in low-income neighborhoods of cities. These problems include violent assaults and alcohol-related motor vehicle crashes. The neighborhoods experiencing these risks are not those that drive the formation of alcohol markets.

Journal Reference:

Zhuxuan Jin, Howard H. Chang, William R. Ponicki, Andrew Gaidus, Lance A. Waller, Christopher N. Morrison, Paul J. Gruenewald. Longitudinal impacts of two causal drivers of alcohol demand on outlet concentrations within community settings: Population size and income effects. Spatial and Spatio-temporal Epidemiology, 2018; 27: 21 DOI: 10.1016/j.sste.2018.07.003

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infant's health; triglycerides; birth defects; alcoholism; addiction; intelligence; poverty and learning; retail and services; resource shortage

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The long-term effects of alcohol demand on retail alcohol markets

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As new study has examined the determinants of the number of licensed bars, restaurants, and liquor stores across neighborhoods in 53 California cities from 2000 to 2013.

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Sedation, dizziness and weakness are among the most common benzodiazepine side effects.

If you're feeling anxious or sleeping poorly, it's tempting to turn to pills to solve the problem. However, prescription sedative drugs known as benzodiazepines carry significant risks, particularly for older adults.

Many people in their 60s, 70s and 80s take antianxiety medications - such as Xanax, Valium and Ativan - sometimes indefinitely. Sleeping pills - such as Halcion and Restoril - meant for short-term use can turn into long-term habits.

Sedation, dizziness and weakness are among the most common benzodiazepine side effects. Depressed mood, headaches, memory problems and irritability can also occur.

Disorientation, balance problems, daytime drowsiness and increased risk of injuries - like falls - are also benzodiazepine side effects. The very problems older adults hope to avoid, such as mental confusion or hip fractures, become more likely.

Even so, physicians keep writing and refilling these prescriptions for their older patients. A new study finds that many patients take benzodiazepine drugs for months on end.

When the generic name of a drug ends with "pam" or "lam," that indicates it's a benzodiazepine.

Valium (diazepam), Ativan (lorazepam) and Xanax (alprazolam) are common medications for treating anxiety disorders. Klonopin (clonazepam), used to control and prevent seizures, is also prescribed for panic attacks. For sleep problems, benzodiazepines approved by the Food and Drug Administration are flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), triazolam (Halcion) and Estazolam (estazolam).

Benzodiazepines are thought to work by affecting chemicals in the brain called neurotransmitters, which communicate with nerves in the body. These drugs appear to enhance the calming effects on the nerves.
Overprescribing to Older Adults
A new review published in the September/October 2018 Harvard Review of Psychiatry looked at evidence of effectiveness and tolerability among older adults with three conditions for which benzodiazepines are commonly prescribed: insomnia, anxiety disorders and dementia symptoms.

For insomnia treatment, 21 of 25 studies showed improved sleep outcomes with use of benzodiazepines. For anxiety, the single related study found a benefit with benzodiazepines when compared to placebos. For behavioral disturbances in dementia, only one of five studies showed improvement compared to placebos.

Overall, the review found that "benzodiazepine prescribing in older adults is significantly in excess of what the available evidence suggests is appropriate," according to research led by Dr. Lauren Gerlach, an assistant professor with the University of Michigan's department of psychiatry.
Staying on Drugs Too Long
Taking benzodiazepines over a long period is problematic, but it's common among older adults, according to another study, also led by Gerlach. Released in September in JAMA Internal Medicine, it focused on nearly 600 adults with an average age of 78 who were newly prescribed benzodiazepines or sedatives.

"We looked at folks who were started on medications by non-psychiatric providers and followed them over the next year." Gerlach says. "We found nearly one in four stayed on these medications long-term. Most of these medications for older adults are really recommended for short-term, if any, use."

Short-term use varies with the patient's condition and symptoms, Gerlach notes. For most people, she says, you would expect roughly one to three months for these medications. However, she says, "Most of the people who were staying on these medications long-term were receiving at least eight months of medication over the following year."

Among study participants, those who received more pills with their first benzodiazepine prescription were more likely to become extended users. "For only 10 additional days of supplied medicine, that almost doubled the patient's risk of continuing into long-term use over the next year," Gerlach says.

Benzodiazepines carry "a host of side effects" for anyone who takes them, Gerlach says. However, risks are amplified for older adults, she says, given changes in how their bodies metabolize, or break down, medications.

Using benzodiazepines to treat people with dementia is not particularly helpful. "Despite benzodiazepines being widely prescribed to patients with behavioral disturbances in dementia, there is little evidence to show that these medications provide any benefit other than sedation," Gerlach says.

If anything, with this class of drugs, "There's been some evidence to show that they can worsen our thinking or cause confusion," Gerlach says. "They may even be linked to an increased risk of developing dementia."

Deaths involving benzodiazepines have been rising, with an eightfold increase from 2002 to 2016, according to the National Institute on Drug Abuse.

While the opioid epidemic draws the spotlight, benzodiazepines come second in terms of dependence and overdose risk. Benzodiazepines are involved in more than 30 percent of opioid-related overdoses, according to the NIDA. Because both types of drugs suppress breathing, taking them together is dangerous.

There are signs of increasing awareness. A study encompassing adults ages 65 and older in the U.S., Australia and Ontario, Canada, found significant decreases in use of benzodiazepines for U.S. and Canada between 2010 and 2016. The prevalence of usage among older U.S. adults dropped from 9.2 percent to 7.3 percent during that period, according to the study published February in the Journal of the American Geriatrics Society. However, use remains "inappropriately high," authors noted, particularly among adults ages 85 and older.

According to the most recent Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, an authoritative set of guidelines from the American Geriatrics Society, benzodiazepines are among the medications to be avoided if possible, although they may be appropriate in some cases.

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Along with memory impairment, falls, fractures and motor vehicle accidents, these drugs are responsible for a significant number of avoidable hospital admissions and emergency department visits, as noted in a May 2015 study in the Journal of Psychiatry and Neuroscience that focused primarily on the use of benzodiazepines to treat insomnia.

Many misconceptions surround sleep, says study author Dr. Cara Tannenbaum, a professor in the faculties of medicine and pharmacy at the University of Montreal. In her work as a geriatrician and consultant, sleep concerns frequently come up in discussions with older patients.

"A lot of people would like to sleep 12 hours a night," Tannenbaum says. "But after the age of 65, your sleep architecture changes and that's not a realistic expectation." It doesn't make sense to medicate patients for perfectly normal sleep patterns, she says. Sleeping only six or seven hours a night, maybe waking up once or twice during that time, is typical for many older adults.

How can you tell if benzodiazepines (or other sedatives like Ambien) are becoming a problem for a family member? Tannenbaum points out possible clues:

Repeating the same question twice in a short period of time

Being off the current date by a day or two and mixing up times for appointments

Forgetting where they parked the car, or misplacing keys, and then being unable to locate them fairly quickly

Driving and missing the street

Stumbling a bit while getting up from a chair

"If somebody told you that they fell, but, 'Don't worry; I was fine,'" that could be a sign, Tannenbaum says. "Maybe the next time they won't be fine."

Medication from a nighttime sleeping pill can linger in the bloodstream until noon or 1 p.m. the next day, Tannenbaum warns. The effect is much worse for women, she adds, as pills remain in the body longer for physiological reasons. Frail, older women face the highest risk of all.
Coming Off Benzodiazepines
Older adults may need help to gradually come off benzodiazepines. For everyone, safer treatments and more effective methods exist to reduce anxiety and improve sleep.

Deprescribing involves stopping or decreasing medications that aren't helping patients and may be hurting them. "We always try to deprescribe benzodiazepines," says Tannenbaum, who is the director of the Canadian Deprescribing Network. It's not safe to quit these drugs abruptly, she adds: "It really has to go slowly because you could have withdrawal symptoms."

The deprescribing process must be done with help from your doctor, nurse or pharmacist, the CDN website emphasizes. The site provides a tapering-off schedule to be followed under the supervision of a health care professional.

If you're having serious trouble falling asleep, a form of counseling called cognitive behavioral therapy could help you get a good night's sleep without medication. With CBT, you learn techniques such as setting a consistent bedtime and wake time, avoiding naps and using your bed for sleep and sex only. Relaxation training and biofeedback also help, as well as tweaking your sleep environment - such as keeping it quiet and cool, and avoiding bedroom clutter.

Anxiety can also be treated more safely. A combination of an antidepressant drug and cognitive behavioral therapy would be recommended as a first-line treatment before the use of a benzodiazepine medication, Gerlach says.

When it comes to benzodiazepines, Gerlach says, it's important for health care providers to be cautious with the initial prescription. Prescribers should focus on short-term use of the medications, she says, and immediately begin the discussion with patients about when to re-evaluate their symptoms, start reducing the medications and eventually come off these drugs.

Lisa Esposito, Staff Writer

Lisa Esposito has been a patient advice reporter for U.S. News since 2014, writing about medica... Read more Lisa Esposito has been a patient advice reporter for U.S. News since 2014, writing about medical and mental health conditions, healthy aging and how patients can receive better hospital care. Prior to joining U.S. News, Ms. Esposito was editor of the Health Behavior News Service, editor of the Baltimore/Washington edition of Gannett's Nursing Spectrum and a freelance editor with HealthDay News.

While at U.S. News, Ms. Esposito has appeared on panels, reported on and contributed to media guidelines on responsible suicide coverage at the U.S Department of Health and Human Services and the Pentagon. In 2016, she won a Media Orthopaedic Reporting Excellence award. Previously, Ms. Esposito worked as a registered nurse in multiple hospitals, starting at the University of Maryland Cancer Center and ending at the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

Lisa Esposito graduated with a bachelor's degree from the University of Maryland School of Nursing and a master's degree in journalism from Georgetown University. She is a member of the Association of Health Care Journalists. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.

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Are Older Adults Taking Benzodiazepines Safely?

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Anxiety and sleeping medications including Xanax, Valium and Halcion are being overprescribed, and seniors are more vulnerable to side effects.

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Current Event 9

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DOVER - More than 1,000 individuals have fatally overdosed in Delaware since the start of 2015, and while the state has made progress in fighting addiction, the opioid crisis is far from over.

After seeing 345 overdose deaths last year, Delaware is on pace to surpass 400 in 2018, the Delaware Department of Health and Social Services said.

On Wednesday the Department of Justice released its annual report on the drug epidemic plaguing the state, highlighting what has been done and what is still needed.

Despite efforts to place stricter guidelines around dispensing opioids, provide to law enforcement medication that counteracts the effects of an overdose and require insurance companies to provide more coverage for drug addicts, plenty of obstacles remain, officials said.

"Any doubt as to the scope of Delaware's opioid crisis was eliminated in September when the Delaware Department of Health and Social Services disclosed that a record-setting 39 Delawareans had died from drug overdoses in August," the report states. "This was not only a record for Delaware, but the death toll was nearly one and one half times the next deadliest month since Delaware began keeping overdose fatality statistics - and the next deadliest month was just last April.

"These shocking monthly numbers come on the heels of annual fatality statistics suggesting that deaths from drug overdoses in Delaware continue to steadily rise."

The number of overdose deaths in the First State has climbed every year since the Department of Justice began issuing reports in 2015, and only four states saw a greater jump from 2015 to 2016, according to the Centers for Disease Control and Prevention.

The report released Wednesday notes there may have been substantially more deaths if not for the expansion of the overdose-reversing medication naloxone, also known as Narcan.

The Department of Justice and the nonprofit atTAcK addiction said 31 of the state's 49 police agencies have naloxone, and there are documented cases of it saving lives.

But even with that medication, the state's opioid overdose rate jumped by 105 percent from July 2016 to September 2017 - three times the average for the 16 states with high prevalence of overdose mortality participating in a CDC study.

"It is the public health crisis of our generation," Attorney General Matt Denn said of the epidemic, which President Donald Trump declared a public health emergency one year ago.

The agency's findings single out a few key areas where improvement is necessary and can save lives: expanding sober living and long-term residential treatment facilities, opening a recovery high school, removing insurance barriers to treatment and creating an opioid tax.

Perhaps the most critical of those is adding space for addicts to receive treatment, especially programs that last longer than 30 days.

"The state has added no long-term residential treatment slots in the last four years, and funded fewer than 30 sober living slots over the same period of time," the report says. "There remain just over 200 treatment beds (none of them for long term residential treatment) to help over 11,000 Delawareans believed to be struggling with substance use disorder. Delaware also has no programs targeted specifically at high school age students with substance use disorder."

Mr. Denn last year requested the state use $4 million to incentivize economic development around long-term treatment and also expend funding for a recovery high school that could hold 25 students. Neither proposal was included in the final budget passed by lawmakers.

Many people receive treatment but are released just a few weeks later and then relapse, the attorney general said. Additional treatment beds, sober living sites and a recovery high school could help prevent that.

The department was also unsuccessful this year in getting legislators to make it easier for doctors to prescribe non-opioid pain management options to patients and to pass an additional fee on opioids.

Lawmakers did approve a bill that aims to popularize other methods of treating back pain, but it falls short of what the agency requested. A measure creating an opioid fee of 1 cent per morphine milligram equivalent, paid by manufacturers, stalled in the General Assembly due to objections from manufacturers and worries of logistical issues raised by several state agencies.

Officials and advocates remain hopeful they can stem the time and save lives.

"I want to be clear that as a state, Delaware has been very progressive and has instituted many first in the nation programs and laws," atTAcK Addiction board member David Humes said in a statement. "But we also know that Delaware's addiction and overdose death problem continues to escalate.

"We are in agreement with the Attorney General's report that there are items that still need attention."

Congress last month passed legislation allocating $3.78 million for opioid prevention and research.
Reach staff writer Matt Bittle at mbittle@newszap.com

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Report: 400 will die of overdoses in Delaware this year - Delaware State News

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DOVER - More than 1,000 individuals have fatally overdosed in Delaware since the start of 2015, and while the state has made progress in fighting addiction, the opioid crisis is far from over. After seeing 345 overdose deaths last year, Delaware is on pace to surpass 400 in 2018, the Delaware Department of Health and [...]

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CURRENT EVENT 10

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There are many different conditions that are recognized as mental illnesses. The more common types include:

Anxiety disorders: People with anxiety disorders respond to certain objects or situations with fear and dread, as well as with physical signs of anxiety or panic, such as a rapid heartbeat and sweating. An anxiety disorder is diagnosed if the person's response is not appropriate for the situation, if the person cannot control the response, or if the anxiety interferes with normal functioning. Anxiety disorders include generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias.

Mood disorders: These disorders, also called affective disorders, involve persistent feelings of sadness or periods of feeling overly happy, or fluctuations from extreme happiness to extreme sadness. The most common mood disorders are depression, bipolar disorder, and cyclothymic disorder.

Psychotic disorders: Psychotic disorders involve distorted awareness and thinking. Two of the most common symptoms of psychotic disorders are hallucinations -- the experience of images or sounds that are not real, such as hearing voices -- and delusions, which are false fixed beliefs that the ill person accepts as true, despite evidence to the contrary. Schizophrenia is an example of a psychotic disorder.

Eating disorders: Eating disorders involve extreme emotions, attitudes, and behaviors involving weight and food. Anorexia nervosa, bulimia nervosa, and binge eating disorder are the most common eating disorders.

Impulse control and addiction disorders: People with impulse control disorders are unable to resist urges, or impulses, to perform acts that could be harmful to themselves or others. Pyromania (starting fires), kleptomania (stealing), and compulsive gambling are examples of impulse control disorders. Alcohol and drugs are common objects of addictions. Often, people with these disorders become so involved with the objects of their addiction that they begin to ignore responsibilities and relationships.

Personality disorders: People with personality disorders have extreme and inflexible personality traits that are distressing to the person and/or cause problems in work, school, or social relationships. In addition, the person's patterns of thinking and behavior significantly differ from the expectations of society and are so rigid that they interfere with the person's normal functioning. Examples include antisocial personality disorder, obsessive-compulsive personality disorder, histrionic personality disorder, schizoid personality disorder,and paranoid personality disorder.

Obsessive-compulsive disorder (OCD): People with OCD are plagued by constant thoughts or fears that cause them to perform certain rituals or routines. The disturbing thoughts are called obsessions, and the rituals are called compulsions. An example is a person with an unreasonable fear of germs who constantly washes their hands.

Post-traumatic stress disorder (PTSD): PTSD is a condition that can develop following a traumatic and/or terrifying event, such as a sexual or physical assault, the unexpected death of a loved one, or a natural disaster. People with PTSD often have lasting and frightening thoughts and memories of the event, and tend to be emotionally numb.

Other, less common types of mental illnesses include:

Stress response syndromes (formerly called adjustment disorders): Stress response syndromes occur when a person develops emotional or behavioral symptoms in response to a stressful event or situation. The stressors may include natural disasters, such as an earthquake or tornado; events or crises, such as a car accident or the diagnosis of a major illness; or interpersonal problems, such as a divorce, death of a loved one, loss of a job, or a problem with substance abuse. Stress response syndromes usually begin within three months of the event or situation and ends within six months after the stressor stops or is eliminated.

Dissociative disorders: People with these disorders suffer severe disturbances or changes in memory, consciousness, identity, and general awareness of themselves and their surroundings. These disorders usually are associated with overwhelming stress, which may be the result of traumatic events, accidents, or disasters that may be experienced or witnessed by the individual. Dissociative identity disorder, formerly called multiple personality disorder, or "split personality," and depersonalization disorder are examples of dissociative disorders.

Factitious disorders: Factitious disorders are conditions in which a person knowingly and intentionally creates or complains of physical and/or emotional symptoms in order to place the individual in the role of a patient or a person in need of help.

Sexual and gender disorders: These include disorders that affect sexual desire, performance, and behavior. Sexual dysfunction, gender identity disorder, and the paraphilias are examples of sexual and gender disorders.

Somatic symptom disorders: A person with a somatic symptom disorder, formerly known as a psychosomatic disorder or somatoform disorder, experiences physical symptoms of an illness or of pain with an excessive and disproportionate level of distress, regardless of whether or not a doctor can find a medical cause for the symptoms.

Tic disorders: People with tic disorders make sounds or display nonpurposeful body movements that are repeated, quick, sudden, and/or uncontrollable. (Sounds that are made involuntarily are called vocal tics.) Tourette's syndrome is an example of a tic disorder.

Other diseases or conditions, including various sleep-related problems and many forms of dementia, including Alzheimer's disease, are sometimes classified as mental illnesses, because they involve the brain.

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Learn more from WebMD about the different types of mental illness.

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Jenn Pelster, holding a packet of syringes and a disposal container, is the lead registered nurse for the Good Neighbor Project syringe exchange program in Mandan, North Dakota on Oct. 15, 2016.A syringe exchange program in Mandan is growing faster than officials expected, enrolling 108 people since opening in January. (Mike McCleary/The Bismarck Tribune via AP)

MANDAN, N.D. (AP) - A syringe exchange program in Mandan is growing faster than officials expected, enrolling 108 people since opening in January.

Jodie Fetsch, director of nursing at Custer Health, told The Bismarck Tribune that the initial goal of the Good Neighbor Project was to enroll about 25 people in the first year. The program provides free sterile syringes and education to prevent the spread of HIV and Hepatitis C.

"We knew there was an IV drug use problem in Bismarck-Mandan, but I don't think we knew the extent," Fetsch said.

The program has seen more methamphetamine use than opioid addiction, she said.

Participants can receive as many as 20 clean syringes once a week if they abide by the program's rules and return used syringes. Participants must meet with a nurse each time and receive education on harm reduction, such as how to prevent an overdose. Nurses offer recommendations for substance abuse treatment, medical services or other assistance.

"It has been wonderful to see people come in and want to stay healthy," Fetsch said. "We're seeing some people entering substance abuse treatment."

The demand for the syringe exchange program, which is the first to open in North Dakota, has led officials to expand hours and look into hiring additional nurses.

The program also changed its policies in July to increase the number of dirty syringes that are collected, according to Fetsch.

Custer Health has given out more than 7,800 syringes so far and collected about 5,700, she said.

Since the program can't use state or federal funding to buy syringes or supplies that would be used for injecting, the Good Neighbor Project is reliant on grant money and donations.

"It's a struggle to get the funding for the injecting supplies," Fetsch said.

The North Dakota Department of Health, which authorizes such programs, is reviewing applications and in discussions with other communities and agencies interested in syringe exchange efforts, according to program manager Lindsey VanderBusch.

"Anything we can do to try to reduce the number of needles people are reusing or sharing with others just reduces the risk of HIV or Hepatitis C transmission," VanderBusch said.

Copyright 2018 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Mandan Syringe Exchange Program Sees Growing Demand

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MANDAN, N.D. (AP) - A syringe exchange program in Mandan is growing faster than officials expected, enrolling 108 people since opening in January.

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The American Cannabis Summit: Countdown to Legalization

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Cannabis is America's 'green gold rush.' In this historic event, Fmr. Speaker John Boehner, along with a team of cannabis insiders, reveal how this new industry can bring you the kind of wealth that lasts for generations.

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Oct. 4, 2018 -- Marijuana may cause long-term damage to teens' brains, a new study finds.

Canadian researchers followed 3,800 adolescents for four years, starting at about age 13, and found that marijuana use had a greater effect on their skills, memory and behavior than alcohol, BBC News reported.

The more the teens used marijuana, the worse these types of problems. And unlike alcohol, the harmful effects on the brain caused by marijuana were lasting, according to the University of Montreal study published Oct. 3 in the American Journal of Psychiatry.

"Their brains are still developing but cannabis is interfering with that," said lead author Patricia Conrod, a professor in the department of psychiatry. "They should delay their use of cannabis as long as they can."

She added that the findings highlight the importance of drug prevention programs, BBC News reported.

Among the teens in the study, 28 percent admitted to at least some marijuana use, and 75 percent said they used alcohol at least occasionally.

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Marijuana a Threat to Teens' Brains: Study

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Oct. 4, 2018 -- Marijuana may cause long-term damage to teens' brains, a new study finds. Canadian researchers followed 3,800 adolescents for four years, starting at about age 13, and found that marijuana use had a greater effect on their skills, memory and behavior than alcohol, BBC News reported.

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Aug. 4, 2000 -- It's called Cold Turkey, and it involves four strangers with a couple of things in common: the tobacco monkey on their backs and a surveillance camera to let everyone watch them squirm while they try to kick their habit. If it sounds a little like Survivor or Big Brother-- that's exactly the idea.

Capitalizing on those popular shows, The Partnership for a Healthy Mississippi placed four young people aged 18 to 21 in a two-bedroom apartment this week in Jackson to be tempted and teased to light up. If they make it through this week (ending Sunday, Aug. 6) without smoking, they'll not only gain the health benefits of going smoke-free, but also pick up $500 each.

But it will not be easy money. The entire struggle will be videocast on a web site, QuestionIt.com, where the viewers get to pick the particular torments, temptations, and humiliations for the participants. It might be a night in a club (chaperoned, of course) where everyone is smoking, a lung-busting aerobics class, or the fictional death of one of them while the others dig his grave and hold a mock funeral. On the other hand, sympathetic viewers also are offering up de-stressors, such as massages.

And just to make things interesting, opened packs of cigarettes will be available in the apartment at all times.

Kelly Wood, spokeswoman for the Partnership, says the point isn't to recommend a scientific way to kick tobacco addiction -- but hopefully to get teen-agers to understand the difficulty of giving up cigarettes so that they won't start smoking in the first place. "It shows teen-agers how tobacco can control your life, and that you can be addicted at a young age," Wood tells WebMD. "I hope they recognize the hassles of nicotine addiction."

The participants -- three men and a woman -- were chosen in a casting call. Above all else, they had to meet one requirement: They had to have a pack-and-a-half a day habit.

A security guard or Partnership representative is on hand at all times to make sure no one sneaks tobacco into the apartment. Wood says the program is not about scandal, but about cravings and tension -- and the web audience has so far chosen challenges and activities in even measures of cruel and kind.

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Aug. 4, 2000 -- It's called Cold Turkey, and it involves four strangers with a couple of things in common: the tobacco monkey on their backs and a surveillance camera to let everyone watch them squirm while they try to kick their habit.

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Journal 8 Heroin & National Drug Take Back

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FRIDAY, Oct. 26, 2018 (HealthDay News) -- It's a twice-a-year ritual now: A day when Americans with unused prescription meds can safely dispose of them as part of National Drug Take-Back Day.

Saturday, Oct. 27, is the latest Take-Back Day, according to the program's sponsor, the U.S. Drug Enforcement Administration (DEA).

From 10 a.m. to 2 p.m., Americans can bring excess pills -- drugs that might otherwise find their way to abusers -- to designated drop-off sites across the country. The service is free and anonymous.

"DEA's National Drug Take-Back Days are important opportunities for people to turn in unwanted and potentially addictive drugs with no questions asked," Attorney General Jeff Sessions explained in an agency news release.

"These Take-Back Days continue to break records," he said, "with the latest [last spring] taking nearly 1 million pounds of prescription drugs off of our streets."

Each year, most misused and abused prescription drugs are obtained from family and friends, including someone else's medication being stolen from the home medicine cabinet, according to data from the U.S. Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health.

In the 15 Take-Back Days held since the program's inception in 2010, Americans have turned in and safely disposed of about 5,000 tons of prescription drugs, the DEA said.

To find the drop-off location near you, head to the DEA collection site finder. The agency notes that it cannot accept liquids, needles or sharps, only pills or patches.

This semi-annual event is an opportunity for Americans "in every community across the country to come together and do his or her part to fight the opioid crisis -- simply by disposing of unwanted prescription medications from their medicine cabinets," former DEA acting administrator Robert Patterson said in an agency news release.

WebMD News from HealthDay

Sources

SOURCES: U.S. Drug Enforcement Administration, news releases, October 2018

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FRIDAY, Oct. 26, 2018 (HealthDay News) -- It's a twice-a-year ritual now: A day when Americans with unused prescription meds can safely dispose of them as part of National Drug Take-Back Day. Saturday, Oct. 27, is the latest Take-Back Day, according to the program's sponsor, the U.S. Drug Enforcement Administration (DEA).

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The measure aims to target the opioid crisis on several fronts, including bolstering treatment access and improving prescription drug monitoring.

One year after declaring the opioid epidemic a public health emergency, President Donald Trump signed what's being referred to as "landmark" opioid legislation into law.

The bipartisan measure aims to address the opioid crisis on several fronts. It increases funding for and access to treatment, improves prescription drug monitoring and makes changes to U.S. Postal Service screening requirements for illicit fentanyl.

It also created partnerships with more than a dozen organizations, including Facebook, CVS and the Red Cross. They will work to create drug disposal programs, simplify medical records and help those who are already in recovery.

During the White House bill-signing event Wednesday, President Trump touted his administration's efforts to confront the epidemic.

"Together we are going to end the scourge of drug addiction in America. We're going to end it, or we're going to at least make an extremely big dent in this terrible, terrible problem," he said.

While experts have applauded the passage of the legislation, some have suggested that focusing on drug prevention is the key to making the measure successful.

Preliminary data from the CDC estimates that 72,000 people died of drug overdoses in 2017.

Additional reporting from Newsy affiliate CNN.

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Trump Signs Sweeping Opioid Legislation Into Law

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The measure aims to target the opioid crisis on several fronts, including bolstering treatment access and improving prescription drug monitoring. One year after declaring the opioid epidemic a public health emergency, President Donald Trump signed what's being referred to as "landmark" opioid legislation into law.

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Miami's CLEAR program

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As communities try to address the drug scourge plaguing the nation, Miami's finest are training to send those suffering with opioid addiction to treatment instead of a jail cell.

Miami Police Chief Jorge Colina announced the new initiative - the Collaborative Law Enforcement Addiction Recovery, or CLEAR, program - at a news conference at Miami's City Hall on Monday.

"I'm hoping it's successful because then the county and other cities across the state of Florida, other departments, can adopt a similar program and then we can really be cooking and save more lives," Colina tells U.S. News. "We're not going to solve this by just sticking people in jail."

Miami Police Chief Jorge Colina

On average, 115 Americans die every day from an opioid overdose, according to the Centers for Disease Control and Prevention. With a little more than $1.6 million in funding from two separate federal grants, Colina says the three-year program is scheduled to launch in May 2019.

"It's really a game changer because the vast majority of that money is going to go to the people who need it," Colina says.

Eldys Diaz, executive officer to Colina and the program director, says if a person found in possession of personal use amounts of opioids denies the treatment option, the officer will follow standard arrest procedures.

"There will be no legal penalty associated with program refusal, and the arrested person will have all of the rights and opportunities afforded to them normally through the criminal justice system," Diaz says.

Colina spoke to U.S. News about the pilot program and its collaboration with several health care partners. The following interview has been edited for length and clarity.
How does Miami's problem with drugs and addiction compare to other cities across the U.S.? What are you seeing on the ground?
We have a problem with drug addiction in general. A lot of our homeless population, they're homeless because they either suffer mental illness or because they're dependent on drugs and that consumes them. We're not like other cities that have just been devastated with overdoses because of fentanyl. We have overdoses here (and) I don't think we're doing as bad as others, but we don't want to wait to get there because we certainly do have a problem.
Tell me about the CLEAR program. What's the goal?
The idea, of course, is we want to try to save as many lives as we can. We know that this is a law enforcement problem, but there's no law enforcement solution - it doesn't work to just put people in jail. That has solved nothing. But perhaps there's a medical solution.

Instead of being arrested you can sign a binding agreement with us that you will receive treatment, and that we can treat your addiction, we can follow you throughout the withdrawal process.
What's included in the binding agreement?
Essentially, what you're saying is you recognize you have an addiction problem, right, because that's important to us that you think, "Hey, it's true I have a problem." You recognize that you essentially don't have control over your own body and mind, otherwise you wouldn't be doing (drugs). You are not a seller, because we don't have any sympathy for the people that are peddling poison. You are a user, so you have to have a "user" amount of drugs on you. And then you agree that what you want is to be clean and be free of this disease, because at the end of the day that's what it is. I know people will think, "Well, those people don't have willpower." No, it's not that, it's that this overtakes your mind and your soul. And so, you agree to those things, and then we want to help you, and working together hopefully will get people help.
The people who enter the program may have a "small amount of opioids" on hand - what does that mean?
So no one misunderstands: (A person who goes through the program) is someone who has a "personal use" amount of drugs, not someone who wants to go out and sell and try to get more people addicted - we don't have any sympathy for those people. Someone who is an addict, who purchased or is using a "personal use" amount of opioids, that's the person that we're looking to help.
The program can only treat 100 people over the course of three years. How do you decide who gets into the program?
When (our officers) come across somebody who is using drugs, opioids - instead of arresting them, you offer them the program. Once we're at capacity, we're at capacity. But it's going to be that simple. We go to a call, someone - an officer - is dispatched. We go somewhere where there are homeless people, for example, and they're sharing a needle and they're using drugs - those are the people that we want to try to help. And I'm hoping that we have success and then private dollars will want to come in to help us not only sustain the program but expand it.
Research shows that the ideal amount of treatment is between 18 and 24 months, but people who participate in the CLEAR program will only be treated for 12 months. Are there plans for after a person leaves the program?
We have a social services element attached to the program where we're hoping that as you become clean and as you become healthy, we're then able to offer, through other departments, resources - whether it's job placement, whether it's shelter if you were homeless, for example. So the idea is that as you become clean, we help you through other departments that we already have to kind of help you get your life back on track.

RELATED CONTENT

One of the challenges that we have is that there are a lot of people that are homeless that are shelter-resistant. So, it isn't just the fact that they don't have a job or they can't make ends meet so they live out of a van,... but a lot of these folks are shelter-resistant because of their addiction and/or mental illness.

For the people that are legitimately in search of permanent housing, we're going to be able to help those people through short term shelter, then transitional shelter and then hopefully to the point that - whether it's themselves or their families - they will be able to get off the street and live somewhere where it is a normal, healthy life. It's going to be fluid - it's just going to depend on the individual. I suspect that we're going to have people that want to be free of their addiction and not necessarily want shelter. Ultimately, the more people we can get off the street and the more people we can help free from that terrible addiction, the better off we all are as a community.
Minority populations may be leery of receiving help from police officers. How do you plan to work on mending those relationships?
For us in Miami, we don't care where you came from, what your status is - we just want to help you. And this doesn't even have to be about drugs or addiction. You raise your hand to flag down a police officer because you need help, my officers know they're going to help you and not inquire, what your status is or where you came from, or any of that. You know, what is your heritage, your nationality, male-female, white-black - we don't care.

What I'm asking the public to do is look at our actions. Forget what we're saying, look at what we're doing. We're going to help you. That is our job and that's what we're going to do. We're going to do everything that we can do to make sure that Miami can become one of the safest cities in the country, in every respect.

Katelyn Newman , Staff Writer

Katelyn Newman is a staff writer for the Healthiest Communities division at U.S. News & World R...Katelyn Newman is a staff writer for the Healthiest Communities division at U.S. News & World Report. You can follow her on Read more Twitter or reach her at knewman[at]usnews.com.

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Miami's Police Chief Colina on Offering Care Before Cuffs

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As communities try to address the drug scourge plaguing the nation, Miami's finest are training to send those suffering with opioid addiction to treatment instead of a jail cell. Miami Police Chief Jorge Colina announced the new initiative - the Collaborative Law Enforcement Addiction Recovery, or CLEAR, program - at a news conference at Miami's City Hall on Monday.

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People living with opioid addiction are increasingly using the inhalation method to get high, warns a new review published Monday in JAMA Neurology. The technique known as "chasing the dragon," which involves heating up heroin and inhaling its fumes through a pipe, may be safer in some ways than injection, but it comes with its own set of devastating side effects, including irreversible brain damage and dementia.

The doctors behind the study, led by neurologist Ciro Ramos-Estebanez of the University Hospitals Cleveland Medical Center in Ohio, were inspired to study the topic after coming across a strange case in 2015. A young woman suffering from opioid intoxication had fallen into a coma. The coma was caused by a buildup of spinal fluid in her brain, a condition known as hydrocephalus. The woman's spinal fluid had become trapped by chronic inflammation in the brain caused by inhaling heroin. She ultimately recovered from her coma, though with lasting cognitive impairment, after doctors performed emergency surgery that drained the lodged spinal fluid.

It was the first case of hydrocephalus linked to inhaled heroin ever reported, and it made Ramos-Estebanez and his team eager to understand the phenomenon better.

"This is something that's unrecognized by physicians-people don't really think about it. And that's a problem," Ramos-Estebanez, also an assistant professor of neurology at the Case Western Reserve University School of Medicine, told Gizmodo. "It's something we can't neglect anymore."

Looking at more than 30 studies and case reports, which included the cases of two other patients at their hospital, the team settled on some basic observations.

For one, while there's sparse information on how often addicts are inhaling heroin, the little data that does exist suggests it's the fastest growing method of use, the team found. In countries such as Sri Lanka, Norway, and India, over two-thirds of heroin users admit inhaling it regularly. In the US, injection is still the most common method, but inhalation is increasing, especially in cities and areas east of the Mississippi. It's also becoming more popular among teens. In 2014, the team found, 21 percent of all inpatient hospital visits due to heroin abuse among 12- to 19-year-olds involved inhalation.

The extent of damage caused by inhaling heroin also runs along a spectrum. At its mildest, it can cause memory loss and mild but long-lasting cognitive impairment; at its worst, it can kill off and create sponge-like holes in the brain's white matter, the bundles of connective fiber that allow brain cells to talk to one another. That can lead to seizures, problems speaking, progressively worse dementia, coma, and death.

Ramos-Estebanez and his team also developed a theory as how and why this damage happens. The high temperatures used to vaporize heroin, they speculate, convert it into a chemical that can cross the blood-brain barrier with greater ease. And because how fast it gets to the brain, these chemicals aren't metabolized by the body into a relatively less toxic substance. The end result is a potent high that is more directly dangerous to the brain.

"Most people who take heroin intravenously don't develop this condition," Ramos-Estebanez said. "You're actually washing out the dose a bit before it gets to the brain."

Inhaled heroin is usually heated on top of aluminum foil to create the fumes. That has led some doctors to wonder if traces of melted aluminum embedded into the vapor are more responsible for the brain-damaging effects. But Ramos-Estebanez notes that little evidence supports that theory. Since there are newer tests that can find aluminum in the brain, though, he supports studies that can definitively settle the debate.

Ultimately, Ramos-Estebanez wants doctors and the public to treat inhaled heroin as an emerging public health problem. Being able to recognize its signs in opioid users earlier might just be life-saving, too: Some small studies have identified a few drugs that seem capable of preventing further brain damage if administered quickly enough.

Some countries, including the UK, allow doctors to offer free foil to heroin users so they can inhale the drug rather than inject it. And while these users don't seem to have the same health problems typically linked to inhaled heroin, Ramos-Estebanez notes that these users are often given support and treatment to wean themselves off addiction at the same time, and they have their doses supervised.

"You're inhaling it in a controlled manner, same as how methadone is used in other countries, so it's like taking any other medication," he said. "But if you don't do it a controlled manner, with heroin off the streets, then you're going to end up in a hospital with a coma."

Outside of these sites, Ramos-Estebanez wants to dispel the notion that inhaling heroin is necessarily safer than other routes, such as injection. Many people, for instance, may inhale to avoid the risk of catching bloodborne diseases through contaminated needles.

"'Chasing the dragon' is not as safe as portrayed. And this isn't something some doctor is saying to scare people away, it's reality," Ramos-Estebanez said. "It's a heavy cost for patients, their families, and society itself."

In addition to creating accurate criteria that doctors can use to diagnose people who have brain damage caused by inhaled heroin, Ramos-Estebanez and his team are also currently trying to establish a registry so cases can be better tracked and studied.

[ JAMA Neurology]

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More People Are Inhaling Heroin, and It's Destroying Brain Tissue

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People living with opioid addiction are increasingly using the inhalation method to get high, warns a new review published Monday in JAMA Neurology. The technique known as "chasing the dragon," which involves heating up heroin and inhaling its fumes through a pipe, may be safer in some ways than injection, but it comes with its own set of devastating side effects, including irreversible brain damage and dementia.

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Current Event 7

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Current Smoking - Delaware Health and Social Services - State of Delaware

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Current report of behavioral risk factor data for tobacco use.

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Psychedelics could lead to a compound inspired drug for PTSD and depression

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American Idol Arrested for Dealing Heroin

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CLOSE

A study says the number of deadly heroin overdoses in the country more than quadrupled from 2010 to 2015. According to the National Center for Health Statistics, there were almost 13,000 overdose deaths involving heroin in 2015, compared to more than 3,000 deaths fatalities five years earlier. The center's research was based on death certificate data and did not examine whether overdoses were intentional suicides or accidental deaths. Heroin has been becoming more potent and cheaper to buy, which may be causing more people to use it, according to a study by the Centers for Disease Control and Prevention. Wochit

Antonella Barba, the fresh-faced singer from Point Pleasant who millions watched during her 2007 run on "American Idol," is locked up in a Virginia jail this morning accused of heroin distribution.

The 31-year-old, now of Los Angeles, was arrested on Thursday. Her arrest was first reported Saturday by TMZ.

The Jersey Shore native made it into the final 16 of the sixth season of American Idol. That year was the show's second-highest rated during its run on Fox as one of the most successful television programs of all time.

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Antonella Barba of Point . Pleasant on "American Idol." (Photo: File photo)

The Norfolk (Virginia) City Jail's website shows Barba was arrested for selling or intending to sell 100 grams or more of heroin, a charge that carries a minimum of five years in prison and as much as 40, according to Virginia law. She is set to appear before a judge on Monday morning.

Heroin is one of a handful of narcotics - Fentanyl and other semi-legal opioid pain medications included - that has fueled a drug epidemic that kills thousands of Americans every year. The video at the top shows how heroin exploded in the last decade.

WHALES: Humpback's aerial show captured off Mantoloking

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Antonella Barba in Point Pleasant Beach. (Photo: Doug Hood)

Barba sang three songs before she was eliminated from Idol, but rankled some during her time on the show after photographs of her - taken prior to her Idol audition - surfaced showing her in various states of undress, including a shot of Barba in a wet T-shirt in the fountain of the National World War II Memorial in Washington, D.C.

After exiting Idol, Barba released the single "Jersey Girl" in 2010 and a pair of Christmas songs in the following years, but never a complete album.

She identifies herself as a singer, violinist and pianist on her Facebook and Instagram pages and notes that she has sung the National Anthem before multiple Dodgers baseball games.

Her official website says "Coming Soon" even though it was created in 2015, the domain registration shows.

Barba's latest national television appearance was on "Jimmy Kimmel Live" on May 21 when she took part in an all-Idol contestant spoof of 1985's " We Are the World."

A message to her management in Los Angeles was not immediately returned.

BELLATOR 208: Fedor TKOs Chael Sonnen in wild Long Island bout
Russ Zimmer: 732-557-5748, razimmer@app.com, @russzimmer
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Antonella Barba, Point Pleasant's teen 'American Idol' star, accused of dealing heroin

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CLOSE A study says the number of deadly heroin overdoses in the country more than quadrupled from 2010 to 2015. According to the National Center for Health Statistics, there were almost 13,000 overdose deaths involving heroin in 2015, compared to more than 3,000 deaths fatalities five years earlier.

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The health risks and effects of environmental tobacco smoke have been well documented for decades.

The 2006 Surgeon General's Report asserts there is no safe level of exposure to tobacco smoke.

126 million people are exposed to the dangers of secondhand smoke.

Toxins and odors from tobacco smoke can drift in the air, into adjacent rooms or apartments.

Cracks under doors, plumbing and electrical conduits, and HVAC ducts can carry the fumes.

Patios and balconies in multi-unit dwellings are easily contaminated by neighbor's drifting smoke.

Most people, smokers and nonsmokers alike, are aware that second-hand smoke is dangerous.

But a growing body of evidence accumulating over recent years shows tobacco toxins persist in indoor environments and automobile cabins, long after the visible smoke is gone.

This residual secondhand smoke has not had a popular name until recently.

The problem is far from new.

Only the name is new.

"Thirdhand Smoke."

Third Hand Smoke

Pediatricians from MassGeneral Hospital for Children in Boston used the name "third-hand smoke" to describe these persisting tobacco residuals in a study that surveyed attitudes and awareness of the risks to infants and children.

Published in the January edition of the journal Pediatrics, the study simply coined a new term, citing existing literature as evidence for the phenomenon.

So now the long term indoor effects of smoking have a name: "third-hand-smoking."

Third-hand smoke is residual tobacco smoke contamination that accumulates in indoor living spaces and on the hair, skin, clothing, and personal effects of smokers.

The Pediatrics survey focused on the personal aspect, and the direct transfer of tobacco toxins to small children from parents and caregivers.

Mainstream media reports of the study have also emphasized the personal aspects of third hand smoking - the odors and contaminants carried on the bodies, hands, and clothing of smokers - but not what I see as the big issue.

Yes, infants and children can be harmed by residual smoke toxins on their parents or caregivers.

What is being overlooked, and of importance to readers of air-purifier-power, is massive contamination of indoor living spaces by long term habitual indoor tobacco use.

3rd hand smoke residuals are toxic particulate that settles onto surfaces and dangerous volatile organic compounds that saturate furniture, carpet, and coat existing house dust.

In 2004, Prof. Georg Matt of San Diego University and colleagues, in a study published in the journal Tobacco Control, found that tobacco by-products were trapped in households, and found in the urine of inhabitants, for several months after smoking ceased.

Matt's group found nicotine throughout smokers' homes. Levels were lower, but still present when residents smoked outside.

Research confirms what chemically sensitive individuals have known for years - smoking in the home leaves persistently high levels of tobacco toxins long after the smoking stops.

These volatile toxic compounds will outgass into the air for months after the last cigarette is gone.

Airborne tar and nicotine from tobacco smoke is carried on air currents, leaving a yellow coating on walls and ceilings, interior surfaces of HVAC ducting, and other hard-to-reach areas.

Don't be fooled by the illusion of TV commercials where they turn on an air purifier and smoke disappears.

This performance cannot be maintained for long.

The film of tobacco residuals is what dramatically shortens the accumulator plate life of electrostatic air purifiers used in smoking environments.

Every HEPA air filter will clog up quickly with tar in homes where tobacco is used.

The odor of tobacco smoke comes from gases in the smoke, not particles. So HEPA filters alone will not remove the smoking smell.

Activated carbon chemical filters will have even shorter service lives where smoking is the norm.

This is one of the reasons why air purifiers cannot make smoking "safe" for non-smokers in a smoking household.

Health Hazards of Third Hand Smoke

Cigarette smoke is a cocktail of over 4000 chemicals. Most of these are persistent.

The health effects of low levels of nicotine vapor and tobacco smoke particulate are not in dispute.

Of approximately 250 known carcinogens found in third-hand smoke, 11 are considered "class 1."

The list of 3rd-hand cancer-causers includes;

ammonia,
arsenic,
butane,
cadmium (causes "smoker's leg"),
chromium,
lead,
hydrogen cyanide,
toluene,
and radioactive polonium-210.

Even at low levels, compounds in third-hand tobacco smoke can effect nerve and brain tissue.

Tobacco particulates have been implicated in cognitive deficits in children, associated with lower reading scores.

Rug Rats in Danger

Third-hand smoke endangers the health of children due to their increased exposure.

Small children are vulnerable when in close proximity, being held and handled by smokers, as was sensationalized by the media.

But rug rats are most exposed to third-hand smoke because they crawl and play on contaminated carpets and furniture.

They touch and mouth toys, stuffed animals, and other items in the dust-laden lower levels of their living space.

Dust particles are not uniformly distributed, but aggregate and settle to the floor.

Only finer particles remain suspended.

Each draft, pet or person walking, and door/window opening stirs up clouds of dust.

Crawling on all fours across carpeting envelopes the very young in a permanent haze, coating the hands they promptly insert in their mouths.

The Matt study estimated 43% of children 2 months to 11 years inhabit smoking environments.

A nicotine byproduct, cotinine, is found in these kid's urine and hair shafts.

Babies whose family smoked nearby measured cotinine levels almost 50 times more concentrated than those in non-smoking households.

Economic Risks of Third Level Tobacco Residues

Buyer beware.

The costs of 3rd-hand contamination are starting to be evident - even the 20% of smokers who don't want to quit are feeling the effects.

Any real estate transaction needs to be looked at carefully - seller concealment of prior smoke damage history is becoming a tort liability issue.

Before you buy a used car, rent an apartment or a house, or buy personal items on eBay, you should investigate the property's smoking history.

Every experienced car buyer or seller knows that smoked-in rides draw fewer resale dollars.

Thirdhand tobacco smoke accumulation in upholstery and carpets is one of several reasons rental cars are turned over frequently.

Many landlords now seek to protect their property with nonsmoking tenancy agreements.

Home contamination by tobacco residue depends on the amount of tobacco consumption and duration of exposure.

A house can incur costly damage from indoor burning - smoking, candles, incense, and poorly managed stoves and fireplaces have run up big bills.

New paint, carpet, upholstery, and drapes can be required before the home is put on the market.

Following the "subprime lending" crisis, these smoky homes are harder to move.

Leather and suede items, including purses, wallets, jackets, and motorcycle safety gear are smoke magnets.

Clothing hanging in closets has been yellowed beyond repair.

Selling high-dollar smoker-damaged leather items without full disclosure is a growing scam on eBay and other online auctions.

Clean Up

At this point, most folks, smokers or not, will want to clean-up this problem and reduce the danger to loved ones and third parties.

Third-hand smoke, especially multi-year accumulation, isn't easy to get rid of.

Once indoor smoking has been stopped, cleanup can begin.

Many have tried to remove thirdhand residues with cleaning solutions and elbow grease, most with limited success.

When you hope to clean before repainting there are very few non-toxic solutions.

I have seen the following proposed;

baking soda,
vinegar,
hydrogen peroxide,
dry coffee grounds,
cat litter absorbents,
placing items in direct sunlight,
running in dryer on low.

My favorite (someone really does this): a can of Coca-Cola (not diet) per load of wash. (One more reason not to use soft drinks.)

I have found many forums where people struggle with tobacco-damaged homes, furnishings, and personal property, using a variety of toxic chemical cleansers and odor-masks, also with limited success.

These will not be listed here.

Odor-masking, using "air freshener" scents that confuse the senses into believing no danger exists, is anathema here.

Tobacco smoke smells bad for a reason, to warn us to move away from poison.

Painters say that primer must be applied first where the plan is to seal toxins and odors under a fresh coat of paint.

Cover-up is not clean-up, and fresh paint has toxic effects of its own.

I recommend a comprehensive residential detoxification plan, especially where an ex-smoker is trying to stay clean.

After years of smoking, subtle vapors trigger addiction responses in the brain, making quitting more difficult in a contaminated home.

For starters, let's oxidize those third hand vapors with shock ozone treatments.

Ozone Generators for 3rd Hand Smoke

The the "laundering" style of tobacco smoke remediation is labor-intensive, expensive, and fails to reach remote contaminated areas, especially hidden carpet pads, drywall, insulation, and HVAC coils/duct work.

Some folks have scrubbed everything, repainted every room, bought new furniture, and replaced carpet/curtains, and still have the smoky stink.

Smoking remediation is one of the few instances where I immediately recommend an Ozone machine.

As a lifetime chemical sensitive and frequent traveler, I have stayed in every class of hotel/motel accommodation far more than I would like to.

Often these are horribly contaminated with third hand tobacco residues.

Cheap outfits often convert smoking rooms to non-smoking by simply removing ashtrays and changing emblems on the door.

Mid-priced motels will often resort to chintzy "air freshener" sprays which mask the odor, do nothing for the toxicity, and may be toxic themselves.

Better hotels have known about this issue for generations, and quietly employ ozone generators and HEPA vacuum cleaners to remove the effects of third hand smoking.

Homeowners can rent ozone machines by the day or week.

For smoke remediation using ozone, the home must be vacant.

In most cases the machine should be rated a minimum 1000 mg/hr O3 output.

2000 mg/hour would be better.

For car detoxification, 400 mg/hr.

Forget the deodorizers hanging from the rear view mirror, they're only fooling you.

Leave the machine running for 1-3 days in each room with the whole-house AC fan running.

To be effective, ozone levels must be higher than humans and pets can tolerate, far above the merely unhealthy concentrations produced by ozone-based "air purifiers."

Professionals will use ozone meters to verify peak O3 concentrations.

Concentrated ozone penetrates walls, carpets, draperies, furniture, and HVAC components.

Odors will disappear fairly quickly, but to oxidize solvents and chemicals the O3 generator must be left on longer.

Air the house out completely before reentry.

Ozone will kill mold and eliminate other odors, but does not destroy particulate.

Everything must now be carefully washed and vacuumed.

Quality high-powered HEPA air cleaners should now be installed.

Ozone generators are not suitable for routine air purification, they should be run only when all living things are absent!

Can We All Just Get Along?

The dangers of third-hand smoke are very real.

Yet about one-third of smokers will always be in denial, refusing to accept the dangers of third-hand smoking, even while their home's white surfaces visibly yellow from cigarette smoke.

Recent Gallup polls show that 35% of smokers accept the "very harmful" nature of second hand smoke, compared to 63% of nonsmokers.

Third hand smoke will be very hard for some to acknowledge.

I am concerned that this evidence will widen the gap between already harassed smokers and those, like me, who seek protection from their dangerous emissions.

With the evidence that smokers carry toxins on their bodies, we are witnessing the manufacturing of a new minority group.

Some say now is the time to pass even more draconian legislation, banning smoking in private homes and cars.

In my strongly anti-smoking opinion, this is a mistake.

Smoking will never be made completely illegal.

Tobacco was one of the USA's first exports, and is today a multi-billion-dollar entrenched industry.

Government dependence on revenue from tobacco taxes, industry lobbying, and big tobacco campaign money will stall federal action.

Some local jurisdictions talk of banning of all smoking, even on private property.

Three states have passed laws which criminalize smoking in cars when children under 18 are present.

This has produced ridiculous scenes of traffic cops stopping drivers for smoking.

Police have more important work, don't need more unenforceable laws, and will have minuscule impact on the smoking problem overall.

Third hand effects of smoking are concentrated in private homes and vehicles.

These expensive, intrusive, and unenforceable rules won't solve the problem.

Only responsible smoking by adult smokers will.

I believe most smokers, at least the 80% who want to quit, will choose to protect their loved ones and the public once they understand the danger.

Rather than criminalizing smoking we should be asking smokers to take measures to protect nonsmokers from third level contaminants - harm reduction strategies.

One of the easiest remedies is moving smoking outdoors.

This practice alone reduces third hand contamination to one-eighth the levels of indoor smoking.

Wearing a smoking jacket which stays outdoors, washing hands after smoking, and frequent bathing can lower this at very low cost.

Further decontamination procedures can be established as time goes on.

Compressed air hoses are widely used in industry to remove particulate.

High-tech cleanrooms have air-suction chambers to remove even the finest particles at entries.

Solutions can be found.

Smoking, as many marijuana brownie munchers can attest, is not the only method of drug use.

US President Barack Obama, struggling to quit smokes, chews Nicorette gum while confronting a White House smoking ban instituted by Hillary Clinton as First Lady.

Pharmaceutical aids for smoking cessation, some available over the counter, can stop the emissions without the suffering of cold-turkey withdrawals.

Prescription nicotine replacement therapy (NRT) is an alternative that produces no emissions.

In the long term, additional laws will not solve the smoking epidemic, currently affecting over 20% of Americans and spreading globally.

Smoking has to become socially unacceptable to young people.

80% of adult smokers took their first puff before the age of 18.

3,000 kids a day start smoking, including an average 20% of high schoolers.

Try telling these kids something is illegal if you want to be sure they rush to do it.

Socialization campaigns targeting pre-teen opinion leaders will do more good, for less money, than any number of totalitarian laws.

Smokers can protect everyone's rights, and their own property, by smoking responsibly and protecting children and others from third hand smoke residues.

End Dangers and Effects of Third Hand Smoke, goto Sitemap

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The health risks and effects of environmental tobacco smoke have been well documented for decades. The 2006 Surgeon General's Report asserts there is no safe level of exposure to tobacco smoke. 126 million people are exposed to the dangers of secondhand smoke. Toxins and odors from tobacco smoke can drift in the air, into adjacent rooms or apartments.

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Cady

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In Delaware and around the country, heroin is in vogue again.

It's a deadly fad. In the last eight months, fatal overdoses from all drugs, including alcohol, have jumped from 12 to 15 a month. Heroin's resurgence is to blame for the rising death count, state officials say.

The problem is everywhere, and in all sections of New Castle County, from the Hunter's Run Trailer Park in Bear to the upscale Country Creek community near Newark. Some users died in bedrooms, others on bathroom floors. One was found in a shed behind a home in Chelsea Estates. Another was lying on a driveway in Bear.
Resources: Where to get help
The victims in the 15 suspected heroin deaths that New Castle County Police responded to so far this year range in age from 22 to 51 years old. Nearly a third of them were female. All but one of them was white. Some already had been through drug rehab before heroin killed them. Four had been released from jail within days of their deaths.

Eight of the deaths statewide have been due to heroin laced with fentanyl, a synthetic painkiller added to the heroin to make it stronger and more attractive to the addict.

U.S. Attorney General Eric Holder calls heroin an "urgent public health crisis" in America. Delaware Health and Human Services Secretary Rita Landgraf says it's an epidemic.

New Castle County Police Chief Elmer Setting, who once forced his teen daughter to watch an OD victim in a body bag get rolled into a medical examiner's van, said the drug is his department's top priority.

By all accounts, the latest spike in heroin use is a result of a successful crackdown on the abuse of prescription painkillers such as Percocet and Oxycontin. Doctors began to prescribe the drugs less and manufacturers made the tablets harder for addicts to crush so they could snort or inject them.

The cost of the pills skyrocketed as the supply dried up. Today, a single 30-milligram Percocet can cost $30, according to David Dongilli, the special agent in charge of the DEA for Pennsylvania and Delaware.
Heroin takes over
The heroin market responded with a drug that is more plentiful, purer and cheaper than ever before, Dongilli said. Twenty years ago, heroin was 17 percent pure and cost $10 a bag. Today, it's around 67 percent pure and can be purchased in Wilmington for as little as $3 a bag. Even novice users from the suburbs know which parts of the city to visit to find a willing seller.

At least 1,990 people each year who have sought treatment from 1998 to 2009 cited heroin as their primary drug of choice, state treatment numbers show. The number dipped to 1,529 in 2010, when the treatment numbers for other opiates such as Oxycontin and Percocet soared, state statistics show.

The crackdown on prescription opiates took effect last year. In 2012, 1,793 people sought state-funded treatment for the prescription painkillers. That number dropped to 1,261 in 2013.

Heroin clearly took its place. In 2012, 1,845 people sought heroin treatment. In 2013, it was 2,750, the highest number since at least 1987.

Dongilli said the bulk of Delaware's heroin comes from South America and travels through Mexico. Most of it arrives in New York City in bulk and gets processed in mills, where it's cut and bagged into individual doses.

It makes its way to Delaware on I-95 to Wilmington.

Wilmington's Vice Squad Commander Steve Barnes characterized the city as partly a retail spot for northern New Castle County's heroin trade, and partly a wholesale hub that supplies places such as Dover and Millsboro in downstate Delaware, as well as Elkton, Maryland, and Kennett Square, Pennsylvania.

While heroin sales have clearly branched out into New Castle County in recent years, Barnes said there's still a steady stream of young, white heroin addicts who come to Wilmington for heroin. Often, they buy in bulk and sell to their friends.

"We get college kids from Newark who meet dealers in the Adams Four parking lot to buy heroin for weekend parties," Barnes said. "They mark up the price, because they had to risk getting arrested, robbed or shot when they came and got it."

Police say seizures are getting larger. The DEA's Dongilli said a decade ago, he'd call a press conference if his agent confiscated a single kilogram of heroin. Now, that doesn't even warrant a press release, as multi-kilo seizures are the norm. Similarly, Barnes said arresting someone with a log of heroin - 10 bundles, or 130 bags - used to be a big deal. Now, two logs is considered a small seizure.
Addicted in weeks
State police have been making big heroin arrests on the interstate recently as well. In separate arrests on May 7, troopers took 40,000 bags from a car on Del. 1 near Middletown and 13,000 bags from a car in Claymont.

The euphoric rush of heroin is all encompassing. Addicts talk about feeling warm all over, like a full-body orgasm. Ask them about their first shot, they get a forlorn look on their face as though they're thinking about their favorite childhood pet.

"It sells itself," recovering addict John Dynan from Wilmington said. "You don't have to market it."

Public health officials issue cautionary press releases when fentanyl is found in heroin, because three grains of it can kill an addict. But for some addicts, the news makes them want it even more, because a fatal overdose means the dope was good.

"When somebody falls out, it definitely made the block hot," recovering addict Chad Golt said.

New Castle County paramedics have been busy this year with the spike in heroin use. They administer the opiate-blocker Narcan on a daily basis. They're no longer surprised, however, when they aren't greeted with gratitude by the addict whose life they just saved.

"Quite often, they're angry because we ruined their high," Chief of Emergency Medical Services Lawrence Tan said.

While heroin feels good in the beginning, the romance is brief. Users can become addicted in weeks and are soon using it purely as maintenance, to avert the symptoms of withdrawal.

"That's why the potential for fatality and devastation from heroin is so extreme," said Mandell Much, clinical director at the ARGO Institute, an outpatient clinic for young adults in Price's Corner. "I've known plenty of binge coke users. There are no social heroin users."

The fun ends quickly. Addicts come from all walks of life, but their lives soon take nearly identical paths. They embark on a twisted road of arrests, car accidents, emergency room visits, job losses and failed relationships. Many steal, usually first from family, then their employers, then strangers.
Filling the void
"You pretty much have to spend every waking hour securing, figuring, finagling, stealing, conniving, cheating and manipulating to get the $200 to $300 a day for your addiction," Much said.

Drugs tend to go through cycles of popularity, treatment experts and law enforcement officials say.

Sometimes it's because of availability. Use of a particular drug will wane because addicts see their older siblings or their friends wind up in rehabs, jails or cemeteries. Eventually, when those morbid reminders fade, a drug returns on to the scene. The National Institute on Drug Abuse (NIDA) calls this phenomenon "generational forgetting."

A drug addict will always find a new drug to use to get high.

"It's always going to be something," Much said. "These people have been damaged, and there's a void in them. We can remove all the heroin from the world and they're still going to have to fill that void."

Setting, the police chief, understands that record-setting heroin seizures are a drop in the bucket of the product that's on the street. And that another substance would replace it anyway.

"We did a good job with prescription drugs and heroin filled that void," Setting said. "With enforcement, education and treatment, we have to do the same thing with heroin. Then we'll have to take a deep breath and do the same thing with the next thing that comes along."
Special Report: Heroin: Delaware's deadly crisis
Contact Adam Taylor at 324-2787 or ataylor@delawareonline.com.

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Heroin in Delaware: Cheap, pure, plentiful

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In Delaware and around the country, heroin is in vogue again. It's a deadly fad. In the last eight months, fatal overdoses from all drugs, including alcohol, have jumped from 12 to 15 a month. Heroin's resurgence is to blame for the rising death count, state officials say.

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Look Out Supervised Injection Site Coming To Philly

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Philadelphia's plan for opioid safe injection site splits opinion

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More than 1,200 people died of accidental overdoses in the city last year - could bringing users in off the street be the answer?

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Bye Bye Tent City

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How Philadelphia closed homeless 'heroin camps' amid US opioid crisis

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As the epidemic moves to cities, evictions at site raise concern over loss of community and shortage of alternative housing

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Amidst the stark white antebellum columns and vivid green landscapes, the University of Delaware can be highly competitive. Coined a research University, the caliber of intellectual influence can be cutthroat. Residential and Greek life can serve as the heartbeat of social life for the "Fighting Blue Hens" to de-stress from a long week. Although the quest for a degree and booming festivities can go hand and hand, there is one group of individuals who stare a common ground that go far beyond the college experience.

"Our student's are excelling in their academia. They like to call themselves the faces of recovery around campus," states Jessica Estok, the driving force behind the University Of Delaware's Collegiate Recovery Community (CRC). She continued, "One of the overwhelming characteristics of college students in Delaware is to have a friend who has struggled or passed away from addiction."

Delaware And The Opioid Crisis

Delaware has been no stranger to the opioid epidemic and in recent years they have been hit hard. According to the Center for Disease Control and Prevention, Delaware had the ninth-highest drug overdose rate in 2016; the death rate was a 40 percent increase from the year before. Nationwide, drug overdoses accounted for about 64,000 deaths in 2016, a 22 percent increase from 2015, and roughly 40,000 of those deaths can be attributed to opioids. In the 12 months leading up to January 2017, Delaware reported 309 overdose deaths , a 71-percent increase over numbers reported in January 2016 and the highest of the 22 states that reported overdose numbers. Delaware, as a whole, is home to less than a million people.

As heroin and opiate addiction remain the driving factor behind a majority of crime statewide, there are agencies that have been forced to re-evaluate how they respond to those suffering from addiction. However, The University of Delaware has paved their own way to foster recovery as well as to respond to the ongoing opioid crisis.

Building A Recovery Environment

University of Delaware's CRC is not a treatment program, facility or halfway house. While it does provide resources for students in need of clinical resources or referrals, it's main purpose is to build a recovery-friendly environment on campus. "We have a couple students who are in long-term recovery, one has about a year, and another has around six months. There can sometimes be a stigma associated with being in recovery, especially on a college campus. This kind of support and safety can ultimately change an entire college experience for students in recovery," stated Estok.

"We initially began in 2014 and quickly grew from word of mouth," Jessica explained. "We've really been growing organically over the past few years and always receive a ton of support from a number of departments on campus. 1-2% of our population identify as being in recovery and we want to make their presence known."

The University of Delaware's Collegiate Recovery Community consists of a group of students who believe in the importance of supporting one another and fostering recovery as well as including students with family members or friends in recovery. The CRC emphasize's a safe and non-discriminatory setting where students can share about struggles, questions, learn more, and in turn, help each other out.

Stemming from a model of peer to peer support, the program's students have been known around school as leaders and can be seen encouraging one another no matter where they're at in their recoveries. Estok noted, "Each day we're developing a sense of community where others can meet up outside campus, experience recovery, have fun, and go to meetings together.

What's Different About It

What makes this recovery program different is that it is so easily accessible. To join the University's recovery community, there are no formal requirements other than a student be actively participating in their recovery efforts. "We see our students doing much more than that though," Jessica noted.

The program is not counseling based, however resources for those who need it can be utilized. Additionally, there is no application process. A student does not have to be in recovery to be a member of the CRC and those who have even been impacted by an addiction can experience the benefits from this tight knit community.

Jessica explained, "This area of Delaware has lost a lot of young people to the opioid epidemic. One of our collegiate recovery members had a few friends pass last summer. It's important that we include these students who resonate with what the entire state has been going through."

"We don't have an application process, and there are no formal requirements other than a student who is doing something to actively support their recovery efforts. We encourage students to participate in various recovery programs such as: NA, AA, Al-Anon, Smart Recovery, or going to church. The options are limitless."

Blue Hen's Are Breaking The Stigma

Over the past four years, The University has been breaking the stigma while creating a welcoming community around campus - which can be challenging to navigate particularly under a college campus.

"We have a handful of students who are at a place in their recovery where they feel like the can reach out to new students who are actively struggling. They are refreshing advocates with their perspectives on substance abuse. Our students like to make themselves known around campus as an effort to help break the stigma. It's helpful for other students to know there's a solution - there's a way out."

The collegiate recovery community hosts a range of weekly and monthly events for their students in sobriety as well as other's who are curious about addiction recovery. Weekly meetings can offer a range of topics, "If they need to talk about how their week has been they have the space to do that. If everyone is in a good spot we use it to plan events and different things. We're not always locked into one thing," Estok said.

Additionally, recovery Yoga is offered once a week. The CRC is partnered with the Transformation Yoga Project to provide yoga for individuals impacted by trauma, addiction, and incarceration through mindfulness-based yoga. They've also partnered with local advocacy group, " Attack Addiction " to create their own team and take part in a 5K run raising awareness surrounding the stigma associated with addiction.

Leadership opportunities are offered for students to present recovery based programming for organizations and classrooms if they request it. The director stated, "We did have a student that presented at a conference a few months ago. She did an amazing job. Our students are highly engaged and academically successful. They're going a long way."

Speakers are invited onto campus to take part in thought provoking panel discussions following documentaries about recovery and substance abuse. "We've shown 'Generation Found,' 'The Anonymous People,' and this semester we're showing 'Heroin,'" noted Estok.

Naloxone

"This semester we're planning on doing a Naloxone training on campus. It's open to students, faculty, and staff. We're really excited about it."

Naloxone is a life-saving opioid antagonist designed to rapidly reverse opioid overdose. It can quickly restore normal respiration to a person who's breathing has slowed or stopped as a result of overdosing due to heroin or other opioid pain medications.

During this training, students, faculty and staff will be educated to recognize and respond effectively to an opioid-associated overdose emergency. They'll learn the tools needed to administer Naloxone, which can ultimately lead in saving a life.

"Anyone is welcome. We're hoping that this can be an incredibly empowering experience and anticipate to increase our visibility throughout campus. Our evolution has largely been due to our program members and we want to provide them the best opportunities as possible - which can ultimately save lives," Estok said.

What's Next For The University Of Delaware

There's no doubt that University of Delaware is creating a footprint in collegiate community world beyond it's scope, but will continue to break barriers associated with the stigma of addiction.

Their next plan is to focus their efforts on a "Recovery Ally Training" which will consist of a series of short videos around topics associated with Substance Abuse Disorder and Recovery. This will ultimately educate, prevent, and inform people on the dangers associated with substance abuse as well as additionally continuing to break the stigma. They're hoping to launch this within the fall of this year.

"We're strengthening our partnership with residential life and housing. In addition, we are working with student health services to put questions on their radar for students they may come into contact with that happen to be struggling," Jessica said. "We just want to be here for students who need us. Our resources are great, and our students are even greater. They're the one's changing things and who will continue to create a great environment for students to come."

The Collegiate Recovery Community at the University Of Delaware does an incredible job of helping students gain the tools they need to sustain recovery after leaving college and has an unspoken common ground. They're changing the standards of recovery, breaking the stigma, and are providing their student's with more than just a degree.

For more information go to: The University Of Delaware

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Blue Hens Break The Stigma - University Of Delaware

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Amidst the stark white antebellum columns and vivid green landscapes, the University of Delaware can be highly competitive. Coined a research University, the caliber of intellectual influence can be cutthroat. Residential and Greek life can serve as the heartbeat of social life for the "Fighting Blue Hens" to

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Big Pharma Finally Under Investigation

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'They're drug dealers in Armani suits': executives draw focus amid US epidemic

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As the pharmaceutical industry fights off a flood of lawsuits, there's an increased call to investigate the roles of executives pushing opioid painkillers

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Survey reveals new trends in teen drug and alcohol use

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Alcohol and cigarette use are down among teens, but marijuana use has not declined, a new report shows. For the first time, researchers found that more high school seniors smoke marijuana than regular cigarettes on a daily basis. The annual survey of 8th, 10th and 12th graders is out today from the National Institutes of Health's National Institute on Drug Abuse (NIDA).

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Psychiatric Disorders/Substance abuse disorders - Wikibooks, open books for an open world

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Use of psychoactive substances is common in society, and is often socially acceptable, or at least tolerated. Historically, psychoactive substances have served a variety of purposes, including medicinal, social, recreational and religious. In the US, 90% of people report some alcohol use, 80% report some caffeine use, 25% report use of tobacco products, and 37% report having used illicit substances (at least once in their lives).

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Allowing suboxone in the correctional system

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A study in cocaine-addicted rats reports long-lasting increases in the number of neurons that produce orexin -- a chemical messenger important for sleep and appetite -- that may be at the root of the addiction. The study, performed by researchers at Rutgers University, New Jersey, was published in Biological Psychiatry. Restoring the number of orexin neurons to normal, or blocking orexin signaling in the brain, made the rats no longer addicted, suggesting the increased orexin neurons to be essential brain changes that cause the addicted state.

The findings identify a promising avenue for treating addiction with orexin-based therapies. Drugs targeting orexin signaling are already being developed for sleep disorders and eating disorders. "The development of a growing array of drugs targeting orexin signaling creates new opportunities to test new medications for the treatment of addiction," said John Krystal, MD, Editor of Biological Psychiatry.

In the process of studying the role of orexin signaling, first author Morgan James, PhD, and colleagues also found that mimicking the typical binge-like pattern of drug use -- with access to cocaine on-and-off throughout the day -- produced a model that reflected addiction in humans better than the "gold standard" of continuous access. Rats given intermittent cocaine demonstrated behaviors observed in human users, including increased motivation for cocaine, even when they received a painful shock to acquire the drug, depression- and anxiety-like behaviors, and 'relapse' after several months of abstinence.

"Remarkably, these 'addicted' rats had a greater number of brain cells that produce the neuropeptide orexin," said Dr. James. The increased number of neurons was persistent, lasting for at least six months after cocaine use, which might explain why addicts often relapse following long periods of abstinence, said Dr. James.

"The addicted brain appears to become more dependent upon this increased number of orexin neurons," noted Dr. Gary Aston-Jones, the study's senior author. "Lower doses of an orexin blocker were effective at decreasing addiction behaviors in these rats than in those with shorter access to cocaine and that were less addicted."

When people think of addiction, they tend to focus on a single chemical messenger, dopamine, and the reward center of the brain. But this greatly oversimplifies the addiction process -- a complex pattern of brain circuits and multiple brain chemicals contribute to the anticipation, experience, and seeking of reward. "Viewing addiction as mediated by a single neurotransmitter in a single brain region is not only inaccurate, but it prevents us from harnessing the complexity of brain signaling mechanisms in the process of developing treatments for addiction," said Dr. Krystal.
Story Source:
Materials provided by Elsevier. Note: Content may be edited for style and length.

Journal Reference:

Morgan H. James, Colin M. Stopper, Benjamin A. Zimmer, Nikki E. Koll, Hannah E. Bowrey, Gary Aston-Jones. Increased Number and Activity of a Lateral Subpopulation of Hypothalamic Orexin/Hypocretin Neurons Underlies the Expression of an Addicted State in Rats. Biological Psychiatry, 2018; DOI: 10.1016/j.biopsych.2018.07.022

Cite This Page:

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controlled substances; nervous system; brain tumor; psychology research; addiction; cocaine; illegal drugs; brain injury

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Cocaine addiction traced to increase in number of orexin neurons

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A study in cocaine-addicted rats reports long-lasting increases in the number of neurons that produce orexin -- a chemical messenger important for sleep and appetite -- that may be at the root of the addiction. The study, performed by researchers at Rutgers University, New Jersey, was published in Biological Psychiatry.

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Authorities say nearly 100 pounds of cocaine has been seized from a Delaware port where it was hidden in boxes of pineapples headed to New Jersey.

News outlets cite a U.S. Customs and Border Protection release that says a drug-sniffing dog at the Port of Wilmington led authorities to the cocaine Wednesday. The News Journal of Wilmington cites a United Nations report that says the roughly 45 kilograms of cocaine has a street value of more than $7.6 million. The release says the pineapples were from Costa Rica.

The News Journal says Wednesday's seizure comes months after federal agencies launched a surprise inspection at the port's federally bonded warehouses. Citing federal disclosure reports, the newspaper says Adderall and thousands of Xanax pills also have been seized at the port this year.

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Nearly 100 pounds of cocaine seized at Delaware port

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Authorities say nearly 100 pounds of cocaine has been seized from a Delaware port where it was hidden in boxes of pineapples headed to New Jersey. News outlets cite a U.S. Customs and Border Protection release that says a drug-sniffing dog at the Port of Wilmington led authorities to the cocaine Wednesday.

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Growing Opioid Crisis Among Senior Citizens 

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Growing Opioid Crisis Among Senior Citizens 

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Delaware has a new 911 Good Samaritan law aimed at making it easier to help someone overdosing from drugs. The "Kristen L Jackson & John M Perkins Jr. Law," named for two young adults who died, gives legal immunity to people who seek medical assistance when someone is overdosing.

Delaware Gov. Jack Markell signed the law Tuesday. It takes effect in 60 days.

The measure has special meaning for Dave Humes, who attended Tuesday's signing ceremony. His 24-year-old son died of an overdose last spring in West Chester, Pennsylvania. He later learned there was a chance the death could have been prevented, had the people around his son immediately called for help. Instead they left him in his car in a hospital parking lot.

"They didn't ring the bell for the emergency ward, they didn't leave, and call and say, 'Look at the parking lot.' And he sat there for about an hour," Humes said. "By the time someone discovered him, he was dead."

Hume hopes Delaware's new law will prevent other parents and individuals from going through what he did.

Dr. Marc Richman, assistant director of Delaware's community mental health and addiction services, thinks it will make a difference because the rule protects someone calling for help from criminal prosecution.

"For those that may be with the person who is in the midst of an overdose, and they're perhaps using with them, you know, fear comes about," Richman said. "And folks can get awfully paralyzed, as to 'Do I call 911 and get help for the person that I'm with? Or do I get out of Dodge because I don't want to get arrested because I have drug paraphernalia, or I'm high myself or I have charges I'm waiting to be picked up for?'"

The new legislation pertains to situations involving underage drinking but not for all types of illicit drug charges.

Delaware's not the only state with such a law on the books. New Jersey enacted something similar in May.

"Often it's just that phone call that's really a difference between life and death," said Ellen Lovejoy, a spokeswoman with the New Jersey Department of Human Services. "If an emergency responder can get to a person overdosing in a quick period of time, they can save that person's life. A person left unattended while overdosing is likely to die."

Pennsylvania has a law pertaining to underage drinking but not for other types of illicit drugs.

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Delaware enacts 911 'Good Samaritan' law : WHYY

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Delaware has a new 911 Good Samaritan law aimed at making it easier to help someone overdosing from drugs. The "Kristen L Jackson & John M Perkins Jr. Law," named for two young adults who died, gives legal immunity to people who seek medical assistance when someone is overdosing.

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CLOSE

In one of his first drug busts as a Delaware State Police trooper in the late 1980s, Rob Kracyla was part of a team that surrounded a street corner in Seaford.

At the time, the North and Third streets intersection was a problem spot for the small Sussex town. That was when Seaford was a busier place, before DuPont pulled thousands of jobs from its Seaford Nylon plant that it later sold to Koch Industries Inc., which further downsized, leaving behind few business opportunities, jobs and even fewer resources.

Today, the opioid and heroin epidemic has changed the jobs of police chiefs like Seaford's Kracyla. They now have a big city problem with a small-town staff and budget.

"Just last week, we had a heroin seizure of a kilogram of heroin," Kracyla said, adding that those drugs would bring about $700,000 when broken down on the street. "Now, whether that was going to touch Seaford or not, we don't know. But probably parts of it were going to end up here in Seaford. ... That's big-time crime coming into and through this city."

Seaford police discovered a kilogram of heroin in a vehicle traveling on Sussex Highway in mid-July. Both people inside the vehicle were arrested and charged. (Photo: SEAFORD POLICE DEPARTMENT)

Two men from Mount Vernon, New York, were arrested and charged after police said they confiscated the 2.2-pound brick from their vehicle in mid-July.

Discoveries like this are becoming more and more common.

Law enforcement officials say Sussex County has become part of the larger network of drug trafficking that has infiltrated both Delaware and the nation, claiming thousands of lives and billions of dollars.

Dealers use small towns - especially in rural areas - as hubs for their sales.

Even towns like Ocean View, along Delaware's affluent beachfront, have been impacted.

A moment from death in vacant Dover lot, overdose victim is saved

Buried in her senior prom dress, Delaware woman falls victim to heroin's grips

Looking for addiction treatment? Try asking Delaware police

Report calls for 'major action' from Delaware in fight against heroin addiction

"The only difference down here is that they're sleeping in a $500,000 house on the beach instead of a cardboard box on a street corner in Wilmington," said Ken McLaughlin, chief of Ocean View Police Department. "Unfortunately, I think we're going to lose a lot more people before this changes."

Delaware is on pace to see its deadliest year yet from addiction, averaging about one death per day. The non-fatal overdose numbers are even more staggering.

Without naloxone, the overdose-reversing medication, deaths would likely be three to four times higher, say law enforcement officials. In Sussex County, paramedics and rescue personnel administered naloxone 30 percent more times during the first quarter of this year as compared to the end of 2017, according to state data.

This summer, a major overdose spike hit Sussex County. More than half of July's suspected fatal overdoses were recorded here.

"I told everyone, this summer we were going to see an influx at the beaches," said Dan Wright, a retired state trooper who serves as Laurel's police chief. "People don't stop using just because they're on vacation."

Now, these police chiefs are struggling with what to do to combat an epidemic that is overwhelming their resources and increasing crime.

Nearly all of their calls have a drug component, from administering naloxone as the first responder in a largely rural county to solving the latest home invasion or homicide.

"But what are we doing to stop the usage?" asked Wright. "I understand the premise (of naloxone) but are we saving lives or are we just prolonging what's going to happen?"

'It's the new norm'

Cpl. Mark Burton was the first on the scene in Ocean View when a call for two unresponsive men came in.

The men had not shown up for work that day, according to police, and co-workers who went to their home to check on them saw them lying on the floor inside. Both men, described as in their 20s, died from suspected drug overdoses.

The investigation remains ongoing into where the drugs came from and what was in them, Burton said.

"It's a very sad event," Burton said while driving around Ocean View last week. "I just feel horrible."

Delaware's efforts to fight addiction cause more confusion

Having worked as a police officer along Delaware's shore for 17 years, Burton has witnessed the influx of heroin and opioids to towns like Ocean View.

Even in some of the wealthiest communities, what was once a rare occurrence is now a part of nearly every traffic stop and arrest, he said.

Six years ago, heroin was unheard of here.

"Now, it's the new norm," he said.

The epidemic brings a certain kind of fear to police work, too, as the additives to heroin - like the synthetic, potent painkiller fentanyl - become stronger and more deadly. Officers no longer field test any drug that looks like heroin due to the potential for overdose just by touching the substance.

Fentanyl is also what law enforcement officials point to as a driver behind the fatal overdoses ravaging the state. A "bad batch" of heroin - typically marked by a rash of overdoses - often means the white, powdery heroin look-alike has found its way into the latest drug supply.

"Those of us in law enforcement, we've been seeing this tidal wave coming," McLaughlin said. "I'm supplying Band-Aids, but we're really not getting to the root cause of it."

"And if it weren't for Narcan (the name brand for naloxone), we'd be losing a hell of a lot more."

'We didn't solve this'

Community policing takes on a new meaning in Sussex's small towns, where many of the men and women patrolling Seaford and Laurel grew up.

It's made the drug epidemic more personal. The people walking the streets and struggling with addiction are childhood friends or longtime members of the community.

"The epidemic is terrible no matter where you look at it," Wright said.

But unlike his days as a state trooper, where the job could take him through a handful of cities and dozens of miles in just one day, policing in Laurel means he sees the same people consistently.

In some cases, his officers and local emergency responders have repeatedly revived the same people from an overdose.

"The smaller the town, the closer you are to the community," Wright said.

Unlike Seaford, Laurel has no treatment center in town for those struggling with addiction. Neither does Ocean View, which makes connecting people with treatment much more difficult when the closest center is miles away.

More than half of July's overdoses happened in Sussex County, prompting state warning

Even in Georgetown, where Sussex courts and some treatment providers are located, the services aren't enough to meet the demand, said Georgetown Police Chief R.L. Hughes.

Like some other Sussex chiefs, Hughes, too, spent more than two decades with state police, fighting crime with a massive budget on a statewide level. Those dollars don't exist for smaller departments.

"When I came back here (after the state police) and saw the homeless, the addicted folks, what I had been reading and writing about, I really saw it," the chief said. "And it's impacted me."

Now, he is alongside other chiefs pushing for change in policing, connecting those committing petty crimes like shoplifting and thefts to treatment. Though he doesn't have an official Angel program - where police offer access to treatment and a potential reduction or elimination of criminal charges upon completion of a program rather than incarceration - he's carrying out his own variation with Connections Community Support Programs in hopes of reducing death and recidivism.

It's necessary, he said, recalling reading Michelle Alexander's "The New Jim Crow" for the first time. In the book, Alexander details how law enforcement created and carried out the "War on Drugs" that left thousands incarcerated for petty drug crimes while failing to treat addiction.

"It was a hard read for me," said Hughes, acknowledging that as an older, white police officer, he played a role in that war. "They're talking about me and they're right. We didn't solve this."

They still don't have the answers, either.

Most Delaware police officers carry naloxone, and most of those who don't are actively trying to make the medication part of their police tool belt. Some connect those struggling with treatment.

Smaller efforts continue, too.

The Laurel Police Department is moving into the closed Paul Laurence Dunbar Elementary School, which will also be home to a community outreach center and keep police easily accessible. Seaford will "go purple" for overdose awareness and Kracyla is trying to wrangle a purple car to help spread that message.

But as long as the demand for heroin remains high, these chiefs fear the supply will only continue to flood Delaware and beyond.

"There's no deterrent," Wright said. "They fear detox worse than death."

They need a solution.

"If you always do what you've always done, you'll always get what you've always got," Hughes said. "We've got to try a different way."
Contact Brittany Horn at (302) 324-2771 or bhorn@delawareonline.com. Follow her on Twitter at @brittanyhorn.
Read or Share this story: https://www.delawareonline.com/story/news/local/heroindelaware/2018/08/02/policing-delaware-heroin-addiction-sussex-county-delaware/825054002/

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Heroin epidemic moves into Delaware's small towns and swamps police

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CLOSE In one of his first drug busts as a Delaware State Police trooper in the late 1980s, Rob Kracyla was part of a team that surrounded a street corner in Seaford. At the time, the North and Third streets intersection was a problem spot for the small Sussex town.

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Current Event 5 - M. Smith-Elisca

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West Virginia has the highest overdose death rate in the country. Locals are fighting to save their neighbors—and their towns—from destruction.

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Journal 7

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1. About Hydrocodone

2. Short-term Effects of Hydrocodone

3. Side Effects

4. Long-term Effects of Hydrocodone

5. Hydrocodone Dependency

6. Hydrocodone Withdrawal and Addiction Treatment

About Hydrocodone

Hydrocodone is a prescription medication sold under multiple brand names, such as:

The aforementioned trade names are combinations of hydrocodone and acetaminophen. Other trade formulations also exist that are hydrocodone in combination with other analgesic or anti-inflammatory medication, such as ibuprofen.

Doctors prescribe this opioid drug for its pain relief and cough suppressant qualities.

When taken long-term and/or in excessive doses, hydrocodone users are placed at high risk for developing tolerance, addiction, and dependency- due in part to the feelings of euphoria that often accompany the pain relief.

When taken appropriately for pain relief, during limited periods of time-and when adhering to a physician prescription-the risk of opiate addiction is minimized; however, the drug is often misused. Visit our page on the History and Statistics of Hydrocodone to learn more about this drug.

Who Answers?

Short-term Effects of Hydrocodone

The National Institutes of Health (NIH) estimates that 20% of Americans have taken prescription drugs like Vicodin for non-medical reasons- and this type of abuse is on the rise.

More specifically, reports from the Drug Enforcement Administration (DEA) in 2013 claim that more than 24 million people in the US over the age of 12 have used hydrocodone for non-medical reasons.

Even though hydrocodone addiction has traditionally been viewed as a problem among the middle and upper classes due to access to health insurance and ease of getting prescriptions, rates of abuse have been on the rise for people from all ethnic and socioeconomic group as prescription diversion becomes increasingly common.

In the short-term, effects of hydrocodone are primarily to modify pain signaling in the central nervous system through interaction with your body's numerous opioid receptors. As it is a pain reliever, hydrocodone does not work to decrease the source of the pain but rather to change the user's perception of the pain. This feeling is very sought-after, especially from those dealing with pain that is high in intensity or long in duration.

Other short-term, desirable effects of hydrocodone include:

Increased sense of well-being.

Numbness.

Feeling sleepy or lethargic.

Reduced worry and stress.

It's important to keep in mind that this is a prescription medication, so doctors prescribe it for patients who are experiencing some type of pain, possibly chronic, and looking for relief.

Hydrocodone brings the much-desired relief and, as a side-effect for some, a pleasurable high that interacts with the brain's reward circuitry. Both effects help to explain why it is easy to become addicted to or dependent on hydrocodone and other opiate drugs, even in situations where initial use was done according to prescribed parameters.

Opiates and Your Brain

The brain's reward circuitry mentioned above has a lot to do with dopamine. Dopamine is a highly-desirable chemical found in the brain. Hydrocodone works to make more dopamine available in the brain, which produces this positive feeling. Once someone experiences this feeling, they will likely repeat the same behaviors in order to re-experience it.

Side Effects

Long-term Effects of Hydrocodone

Despite the problems it creates, those locked in a cycle of compulsive drug use continue to seek out and abuse the drug in question.

Addiction may be one of the most dangerous long-term effects of hydrocodone use. Hydrocodone is an opiate, or narcotic, similar to codeine, heroin, and morphine. These kinds of substances are particularly risky because you can become addicted even when you are taking them as recommended by your doctor.

Repeated use of hydrocodone frequently leads to tolerance, so you will need to take more of the drug in order to get the same effect as your body becomes adjusted to the dose or frequency. Tolerance can develop remarkably quickly with these medications, becoming noticeable within a few doses taken, in some cases.

Tolerance can easily lead to addiction. Addiction entails problematic, compulsive drug use that negatively impacts multiple areas of your life. Despite the problems it creates, those locked in a cycle of compulsive drug use continue to seek out and abuse the drug in question.

Long-term effects of hydrocodone use can include a broad range of physical problems-from acetaminophen toxicity and liver damage to sensorineural hearing loss. Some of the most damaging results of being addicted to hydrocodone, however, may be the adverse effects on your personal life. Drug addiction can:

In the above cases, someone with an opiate addiction will commit more time, effort, and resources to obtaining and using the desired drug. This will leave fewer resources to manage the other facets of life and can be devastating to those that love that person. However, it is possible to recover. Learn how to help a hydrocodone addict.

Hydrocodone Dependency

Hydrocodone dependency happens when a person cannot function normally without taking the drug. If you or someone you love exhibits any of the following behavior, a hydrocodone dependency may have already developed:

Discover how treatment can help.

Taking too much of the drug at one time.

Not following your doctor's instructions when taking the medication.

Mixing hydrocodone with alcohol or other drugs.

Continuing to take the substance when it is no longer medically needed.

Faking injury to obtain more painkiller medication.

Using hydrocodone without a prescription.

Like all of the prescription painkillers, addiction to hydrocodone presents a unique and troublesome circumstance because it is a legal substance that is typically prescribed by a medical professional. The Drug Enforcement Administration reports that doctors gave out nearly 140 million prescriptions for products containing hydrocodone in 2010, putting hydrocodone at the top of the list of prescribed opiates in the United States.

About 99% of the hydrocodone abuse in the world happens in the US. Opiate addiction is a serious illness and, like other health issues, it requires treatment to overcome the problem.

Hydrocodone Withdrawal and Addiction Treatment

Withdrawal from hydrocodone can cause a number of physical, emotional and mental symptoms. Symptoms range from mild to severe, but most are unpleasant enough to present obstacles to continued abstinence--undergoing a detox process in a treatment center is frequently recommended. Detox centers offer both inpatient and outpatient services, but inpatient centers may be better suited to dealing with the effects of opiate withdrawal.

Withdrawal Symptoms

The physical effects vary from person to person and depend on a number of factors, including how long you have been taking the drug, the dose you are taking, and whether you are mixing hydrocodone with other substances. Common withdrawal symptoms can include:

Treatment

Withdrawal from long-term hydrocodone use can be very unpleasant. The opiate withdrawal syndrome is frequently described as having flu-like symptoms. Despite the potential for some profoundly uncomfortable moments, the opiate detox process is not typically life-threatening.

Any one of these symptoms may be enough to send a user back to the drug for relief, and that is why inpatient treatment centers are a safe, caring and effective place to deal with hydrocodone withdrawal.

Some treatment programs administer medications to ease the patient's withdrawal. This form of medical assistance sometimes involves other potentially addictive substances and is strictly controlled and monitored by addiction treatment professionals.

Treatment focused on the addiction will prove highly valuable moving forward, but another important part of treatment involves discovering why you became addicted and how you can live without the substance in the future.

Mental health treatment, like cognitive-behavioral therapy, can help those addicted to retrain their minds and teach them new ways to deal with pain and other circumstances that led to substance abuse.

Sources:

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About Hydrocodone Short-term Effects of Hydrocodone Side Effects Long-term Effects of Hydrocodone Hydrocodone Dependency Hydrocodone Withdrawal and Addiction Treatment Hydrocodone is a prescription medication sold under multiple brand names, such as: The aforementioned trade names are combinations of hydrocodone and acetaminophen.

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Journal 6

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Journal 5

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You've probably heard of " alcohol abuse," "alcohol dependence," or " alcoholism." Maybe you know the new term doctors use, " alcohol use disorder."

Warning Signs

You may have an alcohol use disorder if you:

Drink more, or longer, than you plan to

Have tried to cut back or stop more than once and couldn't

Spend a lot of time drinking, being sick, or hungover

Want alcohol so badly you can't think of anything else

Have problems with work, school, or family because of your habit (or because you're sick after having alcohol)

Keep drinking even though it has caused problems for you or your relationships

Quit or cut back on other activities that were important to you in order to drink

Have found yourself in situations while drinking or afterward that made you more likely to get hurt

Keep having alcohol even though it made you depressed or anxious, hurt your health, or led to a memory blackout

Have to drink more than you used to for the effect you want

Found that you had withdrawal symptoms when the buzz wore off, like trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, a seizure, or seeing, hearing, or feeling things that aren't there.

If you've had two or three of those symptoms in the past year, that's a mild alcohol use disorder. It's a moderate disorder if you've had four to five. If you've had six or more, that's severe.

How Much Is Too Much?

Keep in mind that a serving of alcohol is:

12 ounces of regular beer

8-9 ounces of malt liquor

5 ounces of wine

3-4 ounces of fortified wine (such as sherry or port)

2-3 ounces of cordial, liqueur, or aperitif

1.5 ounces of brandy, cognac, or 80-proof distilled spirits

Many places over-serve booze. It's easy to do, even at home, if your wine or beer glasses are big.

An alcohol use disorder isn't just about how much you drink. It's also about:

How often you drink

What the effects are

What happens when you try to cut back

If I Think I Have a Problem

If you're worried that you might have alcohol use disorder, don't try to quit cold turkey on your own. The withdrawal can be dangerous. You can get help.

Talking with your doctor is a good first step. He can:

Tell you if you need assistance

Work with you to put together a treatment plan, possibly including medication

Refer you to a support group or counseling.

Sources

SOURCES:

Psychology Today: "What Are the Eleven Symptoms of "Alcohol Use Disorder"?

National Institute on Alcohol Abuse and Alcoholism: "Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5," "What Is A Standard Drink?"

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You've probably heard of " alcohol abuse," "alcohol dependence," or " alcoholism." Maybe you know the new term doctors use, " alcohol use disorder."

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Forced Drug Treatment is it a Good Idea?

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M. Elisca

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On Wednesday, a guard, two nurses and a doctor fell ill and were taken to a hospital after coming into contact with a parole violator who was being processed back into Albion State Prison in Erie County.

On Tuesday, officers found a Suboxone strip - a sometimes abused opioid withdrawal drug - on an inmate, while another inmate earlier in the week defecated a balloon filled with synthetic marijuana at Benner Township State Prison in Centre County.

And on Sunday, an officer "became increasingly disoriented and confused" after touching a white, orange and blue piece of paper an inmate dropped at Smithfield State Prison in Huntingdon County.

Those are among 29 recent incidents of staff exposure to synthetic drugs documented on the Pennsylvania Department of Corrections website. The incidents prompted Gov. Tom Wolf's administration on Wednesday to put all 21 state prison facilities on lockdown for the first time in recent memory. All prisons are closed to visitors and mail service, except the delivery of legal papers, has been halted for 46,768 inmates.

Synthetic drugs are entering the prisons through the mail and the only way to stop it is to cut off delivery, said Jim Barnacle, director of special investigations and intelligence at the Corrections Department. The lockdown is being used to train staff on the need to wear protective gloves and masks, and on how to handle suspected drugs, he said, adding there is no timetable to lift the lockdown.

On Tuesday, two Rockview State Prison clerks reported feeling ill after processing outside mail and inmates' internal forms, department records show. The clerks were taken to a hospital for treatment and the building where they worked was closed.

The drugs - primarily K2, a synthetic form of marijuana - invading prisons are coming from communities dealing with the same problems.

In recent weeks, hospitals have reported an increase in emergency room visits and overdoses believed to be linked to K2, said Ray Barishansky, the Health Department's deputy secretary leading the Wolf administration's Opioid Operational Command Center.

"We are seeing it statewide," Barishansky said Thursday at a news conference in the state Capitol.

The synthetic drugs are being made in domestic labs and imported from Mexico and China, said Capt. Joseph Sokolofski, director of the state police's Drug Law Enforcement Division. The chemicals used to make the drugs are constantly changing to stay ahead of legal prohibitions, he added.

K2, spice and other greenish lab-made cannabinoids look like natural marijuana. It doesn't cause the same reactions, however.

The THC compound in natural marijuana can cause poor muscle coordination, relaxation, delayed mental and physical reactions, and increased appetite, according to federal research. Natural marijuana without THC is used in Pennsylvania and other states as a clinically legal drug to treat certain ailments.

The synthetic stuff, however, can cause violent outbursts, delusions, anxiety, nausea and vomiting, paranoia and suicidal thoughts, among other affects, according to the Pennsylvania Department of Drug and Alcohol Programs.

And it is so potent its effects can transfer to someone who accidentally touches it.

Barishansky warned police and first responders to take extra precautions, such as wearing gloves.

The rise in synthetic drugs in Pennsylvania and other states is a symptom of the nation's ongoing prescription opioid and heroin epidemic, said Jennifer Smith, Drug and Alcohol Programs secretary.

As Pennsylvania has made it harder to get opioids by capping and monitoring prescriptions, addicts are switching to synthetics, she said. She warned the public to call authorities for help if they suspect someone is showing symptoms of synthetic drug use.

"In today's world, we don't know what substance people are using," she said. "Don't try to diagnose or guess what the substance is."

Help options

County emergency services: 911

American Association of Poison Control Centers: 1-800-222-1222.

Federal addiction help hotline: 1-800-662-HELP.
steve.esack@mcall.com Twitter @sesack 717-783-7309

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Pennsylvania details how synthetic drugs are sickening staff and inmates alike in state prisons

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On Wednesday, a guard, two nurses and a doctor fell ill and were taken to a hospital after coming into contact with a parole violator who was being processed back into Albion State Prison in Erie County.

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Current Event 4

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Where Families Find Answers on Substance Use | Partnership for Drug-Free Kids

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Drug trends among teens and young adults today are "not your father's Oldsmobile," so to speak. The whole scene has changed. We continue to have problems with commonly-used mind-altering substances that have been around for a long time such as opiates, marijuana and hallucinogens. Today, however, we add to this list increasingly bizarre practices such as consuming embalming fluid, along with numerous synthetic drugs and organic drugs that are unstudied and often untraceable. Here is an overview of the major drug trends we are seeing nationwide.

Kratom

Today, Kratom has become a hotly-debated drug, often touted as an organic pain-reliever and recently classified as an opioid by the Food and Drug Administration. Despite its widespread use and ease of online ordering, little clinical research has been conducted on this drug making it a risky substance, especially as it becomes increasingly popular with teen and young adults. Though this drug was officially made illegal in Alabama, Arkansas, Indiana, Tennessee, Vermont, and Wisconsin in 2016, Kratom is still legal in many states. Its effects can be severe with more severe side effects including respiratory depression and psychosis. It is also highly addictive.

Synthetic Drugs

Synthetic drugs have become increasingly popular with younger people, and the effects of these drugs can be deadly.

Synthetic drugs include synthetic cannabinoids such as Spice and K2. These drugs are manufactured chemicals that are often sprayed on dried plant material. This allows them to be smoked in a method similar to marijuana. Synthetic cannabinoids are also sold as liquids which can be vaporized in e-cigarettes. Often, these products are labeled as incense and do not come up on standard drug tests, thereby making them dubious to many parents. Common street names include Spice, K2, Genie, Red Magic and Fake Weed.

Synthetic cathinones, commonly referred to as "bath salts," are similar in that they are manufactured substances and are often labeled as "not for human consumption" despite their widespread use as a drug. These mind-altering substances are unregulated stimulants often used as a substitute for cocaine or amphetamines. They can be swallowed, snorted, smoked, or injected and remain popular among teens young adults. Common names include Flakka, Ivory Wave, Stardust, Cloud Nine, Meow Meow, Vanilla Sky, and White Knight or White Lightning.

Since synthetic drugs are largely unregulated and can be highly dangerous and unpredictable, it is imperative that parents familiarize themselves with these substances, which are often mistaken for benign incenses and can be purchased at many local gas stations and paraphernalia shops.

Hallucinogens

In recent years, we have seen a resurgence of hallucinogens among young people. These include more commonly known substances such as lysergic acid diethylamide (LSD). LSD is often taken as a tablet or "blotter." Its effects may be intense and include both visual and auditory hallucinations, altered perceptions, delusions and time distortions. Psilocybin, also known as "Magic Mushrooms," is a naturally-produced psychedelic compound found in species of mushrooms. Dried or fresh mushrooms are often ingested, prepared as a tea or consumed with other foods. Other substances include marijuana cigarettes, which are dipped in solutions to enhance the hallucinogenic effects of THC, with embalming fluid is among the substances used. As one might imagine, this solution can produce disastrous effects, such as decreased lung function and an increased risk of cancer when used recreationally.

Opioids

Opioids continue to be popular among all age groups, including young adults. Young adults consume more prescription medications recreationally than any other age group, sometimes in combination with alcohol, placing them at increased risk for respiratory failure. They are also at high risk for addiction and dependence. Often, physicians find these drugs were illegally and unknowingly obtained from a family member or friend. These addictive substances can lead to heroin and fentanyl use. Opioid use can cause permanent neuropathy among people who overdose or become unconscious from opioids. In a residential treatment setting, it is unfortunately common to see at least one or two patients at any given time with a permanent disability as a result of an overdose.

The Role of the Internet in Drug Use

Today, the internet continues to be a primary source of information about drugs from many young people, with entire sites devoted to explaining drug use. Additionally, young people often report obtaining drugs from site on the "Dark Web," a part of the internet that requires special software or authorization to access and is not found on regular search engines, making them largely untraceable. These drugs are sent via mail, sometimes to a P.O. Box where they can be received without a parent's knowledge. Cryptocurrencies like Bitcoin may also be a source of payment, creating a largely anonymous purchase experience.

What Can Parents Do?

Pay attention to unexplained changes in your child's behavior including school/work performance, general mood, sleeping patterns, etc. These changes may be signs of substance use.

Pay attention to what is happening on computers in your home. Check browsing history regularly and do not ignore unexplained software on your computer. Check for deleted browsing histories and ask questions.

If you discover your child is experimenting with drugs, consider consulting a professional as opposed to trying to figure out the problem yourself.

The most significant thing a parent can do to help kids is to spend time with them. This is just as true with adolescents and young adults as it is for young children. Communicating with your kids and being clear about expectations are a parent's best tools for guiding kids to make healthier choices.

About the author: In his role as Medical Director for Hanley Center, Dr. Barias is responsible for patient medical care on all Florida campuses, as well as overseeing a team of nurse practitioners. He is a medical doctor who specializes in Addiction Psychiatry and General Adult Psychiatry, with expertise in dual diagnosis. Using his in-depth knowledge and understanding of substance use disorders, Dr. Barias tends to his patients in an attentive, responsive and considerate manner to ensure their safety and well-being. Dr. Barias completed his General Adult Psychiatric Residency at Elmhurst Hospital Center, and his Fellowship in Addiction Psychiatry at Mount Sinai Hospital and James J. Peters VA Hospital. He is a member of the American Academy of Addiction Psychiatry (AAAP) and the American Society of Addiction Medicine (ASAM).

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What Are the Current Drug Trends Among Teens and Young Adults? - Where Families Find Answers on Substance Use | Partnership for Drug-Free Kids

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Drug trends among teens and young adults today are "not your father's Oldsmobile," so to speak. The whole scene has changed. We continue to have problems with commonly-used mind-altering substances that have been around for a long time such as opiates, marijuana and hallucinogens.

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https://www.pressofatlanticcity.com/news/atlantic-county-to-unveil-hope-one-addiction-outreach-van/article_3ad255c0-62a4-56db-b3f2-e4ae5d55f31f.html

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HAPEVILLE, Ga. - Drugs disguised as candy that a suburban Atlanta police department confiscated late last week after a hit-and-run accident should be a warning for all those who interact with kids - especially with about a month to go before Halloween - investigators said Monday.

Officers on Friday seized suspected cocaine and marijuana plus a cache of cannabis lollipops and pills in the shape of Hello Kitty, Homer Simpson and the Minions from Despicable Me that a kid might mistake for sweet and sour candy, Hapeville Police Department officials posted on Facebook.

"Our concern is these pills look like candy," department officials said Monday in response to a message from USA TODAY on Facebook. "Small children might ingest these items mistaking them for candy. Teens may see these drugs as less of a danger based on their looks."

Hapeville, a city of about 6,500 residents that sits northeast of Hartsfield-Jackson Atlanta International Airport, and has had about a dozen drug arrests in the past six months, according to incident reports posted on CrimeReports.

► May 17: Philly kindergarten teacher finds bag of crack cocaine in mouth of girl, 6 ► Oct. 31: Meth found in trick-or-treat bag, so this whole town tossed their candy ► May 2017: Drug-laced 'SweeTARTs' seized; parents warned

Friday's seizure, which occurred after a suspect ran from the scene of car accident with injuries but left behind his computer bag, was not listed among incidents reported from March 28 to Monday. The department did not release the name of the suspect arrested but added a comment Monday to its post saying that charges so far included leaving the scene of an accident with injuries, possession of a stolen gun, possession of a firearm by a convicted felon, possession of cocaine and possession of drugs with intent to distribute.

Hapeville Police Chief Richard Glavosek did not return a phone call Monday from USA TODAY seeking additional information.

Though Hapeville police have not confirmed the types of drugs that officers confiscated, in the past similar multicolored pills were found to be MDMA, better known as ecstasy or molly. And while pot edibles are legal for recreational use in nine states and the District of Columbia and for medical use in another 30 states, Georgia is in neither of those categories, according to the National Cannabis Industry Association.

► April 2016: Weed-laced gummy candy leaves Florida kids in hospital ► May 2014: Marijuana 'edibles' pack a wallop

"What reason would a drug dealer have to offer drugs that appear to be candy except to entice young people?" the department said in its response Monday.

Last year close to Halloween, police in South Florida warned parents after Franklin County, Florida, deputies confiscated a mason jar filled with rock candy that tested positive in the field for bath salts, a type of drug that contains the stimulant cathinone and is not related to epsom salts used in bathing, reported WCTV-TV, Thomasville, Ga. Further tests at the Florida state drug lab in Tallahassee came back negative a month later.

Though giving away pot edibles, ecstasy or bath salts as Halloween treats would be an expensive proposition, Hapeville police said this incident is a good reminder for parents, teachers and coaches to warn children about the dangers of drugs before the season where kids are encouraged to take candy from strangers. An adult should check all Halloween candy before children are allowed to eat their sweets.
Contributing: Ashley May and Linda Dono, USA TODAY. Follow Christopher Buchanan on Twitter: @ChrispyBuc
Read or Share this story: https://usat.ly/2IdnRbo

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Drugs that look like candy have police worried that similar pills are out there close to Halloween

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HAPEVILLE, Ga. - Drugs disguised as candy that a suburban Atlanta police department confiscated late last week after a hit-and-run accident should be a warning for all those who interact with kids - especially with about a month to go before Halloween - investigators said Monday.

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Powdered Alcohol and Likelihood of Abuse Among a Sample of College Students and Pertaining Laws 

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Powdered Alcohol and Likelihood of Abuse Among a Sample of College Students and Pertaining Laws 

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http://www.ncsl.org/research/financial-services-and-commerce/powdered-alcohol-2017-legislation.aspx

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Powdered Alcohol and College age students

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Journal 4

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NIDA.NIH.GOV | National Institute on Drug Abuse (NIDA)

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NIDA's mission is to advance science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual and public health. NIDA is one of the National Institutes of Health.

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Journal

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Combining Drinking and Drugs

Alcoholism increases the likelihood of developing co-occurring conditions such as a substance use disorder. Mixing alcohol and other drugs together can lead to serious physical, behavioral and health complications. Not only can drinking and drugs increase the effects of each substance, it can also trigger dangerous interactions.

Individuals who abuse alcohol are also more likely to abuse other substances, like prescription or illicit drugs. Illicit drugs - cocaine, heroin, ecstasy and marijuana - can cause severe bodily injury and life-threatening side effects. Drinking and taking drugs can quickly spiral out of control, leaving you at risk for potentially permanent health complications.

Disorders surrounding alcohol or substance abuse should not be self-treated. A specialized drug and alcohol treatment center will be able to help you through every step of the recovery process, giving you the greatest chance for lasting recovery. Contact a treatment expert now to find top-rated rehab facilities nearby and get started on your journey to recovery today.

Substance Abuse

Substance abuse involves the chronic use of alcohol and drugs. A person who abuses alcohol has a greater risk of using at least one other substance, such as marijuana, cocaine and heroin. Prolonged consumption of drugs and alcohol increases your tolerance, therefore requiring more of the substance to achieve the same desirable effects.

Alcohol and substance abuse can start out as a mild problem and gradually turn into more severe problems. For example, a person may mix small amounts of alcohol with a drug. Over time, their body becomes dependent on the chemicals released by each substance and begins craving more. After you've built a tolerance to both substances, you may increase the amount consumed in order to avoid experiencing uncomfortable withdrawal symptoms. In these cases, some individuals may turn to more addictive substances - heroin, cocaine and ecstasy - to experience an intensified high.

Recognizing the warning signs of of alcohol and substance abuse is key to getting help early. If left untreated over a long period of time, problems with drinking and drugs can escalate and become life-threatening.

Recognizing a Drug and Alcohol Problem

While some symptoms of alcohol and drug abuse are noticeable and can be caught early on, others may not be as recognizable. Warning signs sometimes go unnoticed when an individual hides their drinking and drug problem. Due to the stigma and negative connotations associated with alcohol and drug abuse, many people may deny they have a problem at all. In these circumstances, it can be difficult for close friends and family members to prepare an intervention and get their loved one the help they deserve.

Here are several questions to identify whether you or a loved one may be suffering from alcohol and drug abuse:

Have you felt irritated by the concern or criticism of your alcohol or drug use by those around you, like family members, friends, a colleague or teacher?

Have you ever thought of reducing your drinking or drug intake?

Have you felt guilt over your drug and alcohol consumption?

Do you find yourself craving a drink and other substances periodically throughout the day?

In the last year, have you failed to meet an obligation because of drinking and drugs?

Have you or someone else been injured due to your alcohol and drug abuse?

If you answered "yes" to one or several of these questions, you should seek help from a medical professional. These answers should not be considered an official diagnosis; however, they can warn you of potential substance abuse factors and motivate you to get help.

The Dangers of Drug and Alcohol Abuse

Depending on the amount of alcohol and type of drug consumed, you can experience an array of harmful side effects. Since alcohol is a depressant, mixing it with another drug can be detrimental for your health.

Here are the most common drug and alcohol combinations, as well as their specific dangers:

Cocaine and Alcohol

Cocaine and alcohol use is one of the most common combinations among drug users because of the powerful high that both substances produce. Cocaine is a stimulant that increases your blood pressure, heart rate and alertness. This helps alcohol reach the brain quicker. Mixing cocaine and alcohol causes cocaethylene, which produces intense feelings of pleasure. Other risk factors of combining cocaine and alcohol include heart attack, overdose or death.

Heroin and Alcohol

Both heroin and alcohol are depressants which can cause similar side effects. One of the most dangerous risks of depressants is slowed breathing. When you consume heroin with alcohol, these breathing problems can be even more serious and life-threatening. Heroin is a highly addictive drug, so it can prove difficult to quit. The consumption of both heroin and alcohol can also lead to an extremely slow heart rate and overdosing.

Ecstasy and Alcohol

Ecstasy is a stimulant that can cause severe adverse reactions when consumed with other substances, including alcohol. The powerful high experienced while taking ecstasy influences you to drink large amounts of alcohol in a short period of time. This can trigger extreme dehydration, among other side effects such as diarrhea, excessive sweating, heat stroke, nausea and vomiting.

Marijuana and Alcohol

Because both drugs are depressants, combining marijuana and alcohol increases the likelihood of an overdose. Both substances can cause dizziness, nausea, vomiting, high anxiety and paranoia. However, since marijuana reduces symptoms of nausea, it may prevent your body from throwing up alcohol. This can cause alcohol to remain in your system and potentially lead to alcohol poisoning.

Painkillers and Alcohol

Painkillers like Vicodin, Xanax and OxyContin are heavily prescribed in the United States to treat moderate to severe pain. When used with alcohol, these drugs can produce dangerous health conditions. Taken separately, painkillers and alcohol may cause liver damage. However, when the substances are combined, you significantly increase your risk for developing liver problems and possibly liver disease.

Antidepressants and Alcohol

Individuals with a mental health condition are typically prescribed an antidepressant such as Zoloft or Prozac. Mixing an antidepressant with alcohol can worsen the side effects of each - a potentially deadly combination. One of the biggest risk factors of consuming alcohol and antidepressants is feeling more depressed or anxious. This can lead to irritability, an inability to sleep and impaired judgment.

Sleeping Pills and Alcohol

There are various risks to taking sleeping pills on their own. However, when combined with alcohol use, the effects of sleeping pills can be life-threatening. Drinking even a small amount of alcohol while taking sleeping pills can increase its sedative effects. When mixed with alcoholic beverages, a sleeping medication can produce dizziness, confusion and faintness.

No one should ever drink large amounts of alcohol when taking prescription medications especially opioids, anxiety pills, or sleeping pills. All of these drugs are sedatives and mixing them with alcohol can cause profound drowsiness, respiratory depression and even death.

Alcohol and Drug Use Side Effects

Consuming excessive amounts of alcohol and drugs over the course of days, weeks or years can take a toll on your body. Some effects may be minor and only last temporarily. Other effects may last much longer and can cause permanent damage. Generally, the amount of alcohol consumed and type of drug involved influence health consequences. For example, alcohol mixed with heroin has more severe consequences than a less dangerous drug like tobacco.

Several short-term alcohol and drug use side effects are:

Increased or decreased heart rate

Muscle control difficulties

Lowering inhibitions

Short-term memory loss

Heightened emotions of sadness, anxiety or fear

Lack of concentration

Respiratory problems

Along with the temporary side effects of alcohol and drug abuse, there are complications that can be long-lasting. Some of these conditions can put you at a greater risk of developing additional health issues later on in life.

The long-term effects of alcohol and drug abuse include:

Damage to internal organs

Muscle and bone breakdown

Long-term memory impairment

Lack of coordination skills

Problems coping on the job or in school

Poor nutrition

Nasal perforation (in cocaine abuse)

Learn more about treatment
Treating Drug and Alcohol Abuse

Drinking and drugs can destroy your relationships with family and friends, your career and your health. While you may feel as though there's no end in sight, help is available. Alcohol and substance abuse are treatable conditions that can be overcome with the help of treatment specialists. Unfortunately, these conditions are often under-treated due to a lack of knowledge about recovery programs available.

What Are You Waiting for?

It's time to turn the page and start a new chapter - your journey to lasting recovery. There are many treatment options available, including inpatient rehab, government facilities, counseling and support groups like Alcoholics Anonymous and AI-Anon. Find out more.

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Alcoholism and Drug Use - A Dangerous Combination

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Alcoholism increases the likelihood of developing co-occurring conditions such as a substance use disorder. Mixing alcohol and other drugs together can lead to physical, behavioral and health consequences. Not only can drinking and drugs increase the effects of each substance, it can also trigger dangerous interactions

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Current Event 3

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The Drug Enforcement Administration has proved itself incompetent for decades.

By Leo Beletsky and Jeremiah Goulka

Professor Beletsky is the faculty director of Northeastern University's Health in Justice Action Lab, where Jeremiah Goulka is a senior fellow.

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An air tank is seen before a press conference about fentanyl at the headquarters of the Drug Enforcement Agency June 6, 2017 in Arlington, Virginia. Credit Credit: Brendan Smialowski/Getty

Every day, nearly 200 people across the country die from drug overdoses. Opioids have been the primary driver of this calamity: first as prescription painkillers, then heroin and, more recently, illicitly manufactured fentanyl. The death toll has risen steadily over the past two decades.

The Drug Enforcement Administration, the agency that most directly oversees access to opioids, deserves much of the blame for these deaths. Because of its incompetence, the opioid crisis has gone from bad to worse. The solution: overhauling the agency, or even getting rid of it entirely.

The problem begins with poor design. A brainchild of Richard Nixon's "war on drugs," the agency sought to cut off supplies of drugs on the black market, here and abroad. But in passing the Controlled Substances Act of 1970, Congress also gave the agency broad authority over how prescription opioids and other controlled substances were classified, produced and distributed. The agency was supposed to curb problematic drug use, but failed to do so because its tactics were never informed by public health or addiction science.

Despite the investment of hundreds of billions of taxpayer dollars and the earnest efforts of thousands of employees, the D.E.A.'s track record is abysmal. The agency has been unable to balance legitimate access to and control of prescription drugs. The widespread over-reliance on opioids, along with benzodiazepines, amphetamines and other scheduled medications, has created a booming black market.

read more on the opioid crisis

The United States was ill equipped to navigate the worst drug crisis in its history with the D.E.A. at the vanguard. Starting in the late 1990s the manufacturing, distribution and prescribing of opioids began to increase rapidly. Overdose deaths soared since so many people were prescribed opioids and many mixed them with alcohol and other sedative drugs. The D.E.A. could have marshaled a calibrated response, expanding evidence-based treatment and reducing the prescription of especially risky drug combinations.

Instead, the agency pushed for surveillance of prescription records and electronic communication, doubled down on prosecuting prescribers and helped to tighten the screws on patients seeking pain relief. Meanwhile, lifesaving opioid treatments that the D.E.A. closely regulates, like methadone, have remained extremely difficult to obtain. Indeed, these problems were much broader than the alleged industry machinations to muzzle the agency.

A decade into the crisis, more and more prescription drug users turned to the black market. Even though the D.E.A. had tried to "eradicate" illicit drugs for nearly 50 years, users could easily buy stolen and counterfeit pills, along with a cheaper option, heroin. Soon, some began injecting. Outbreaks of H.I.V. and hepatitis C followed. Meanwhile, people who sought evidence-based treatment were rarely able to access it because of the agency's evolving regulatory and enforcement strategies, like blocking the expansion of mobile methadone clinics and shutting down addiction treatment providers without arranging alternatives for affected patients.

As the engine of overdose deaths shifted from prescription drugs to heroin, the D.E.A. turned to its supply-reduction playbook. This resulted in a major uptick in heroin seizures and high-profile prosecutions, which encouraged traffickers to create more compact, potent drugs. In a single year, from 2014 to 2015, deaths involving the synthetic opioid fentanyl and its analogues almost doubled, setting the stage for its current role as the principal driver of overdose fatalities. And since 2015, the agency has not had an appointed administrator.

We urgently need to rethink how our nation regulates drugs. What should our goals be? How can we design institutions and performance metrics to achieve them?

The answers lie at the local and state levels. In Rhode Island, opioid overdoses are declining because people behind bars have access to effective treatment. Massachusetts has deployed drop-in centers offering treatment, naloxone and other services. San Francisco and Seattle are planning to open safe consumption spaces which show tremendous promise as a tool to reduce overdose deaths and other drug-related harm. But the D.E.A. and its institutional parent, the Justice Department, stand in the way of some of these experiments.

We ought to reinvent the Drug Enforcement Administration. Considering its lack of public health and health care orientation, the agency's regulatory authority over the pharmaceutical supply could be transferred to a strengthened and independent Food and Drug Administration, while the regulation of medical and pharmacy practice can be ceded to the states. Parts of the D.E.A.'s law enforcement mandate should be transferred to the F.B.I., delegated back to the local or state, or eliminated. A significant portion of the D.E.A.'s budget should be reinvested in lifesaving measures like access to high-quality treatment.

The Drug Enforcement Administration has had over 40 years to win the war on drugs. Instead its tactics have fueled the opioid crisis. To finally make a dent in this national emergency, we need to rethink the agency from the bottom up.

Leo Beletsky, an associate professor of law and health sciences at Northeastern University, is the faculty director of the Health in Justice Action Lab, where Jeremiah Goulka is a senior fellow.

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Opinion | The Federal Agency That Fuels the Opioid Crisis

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The Drug Enforcement Administration has proved itself incompetent for decades. By Leo Beletsky and Jeremiah Goulka Professor Beletsky is the faculty director of Northeastern University's Health in Justice Action Lab, where Jeremiah Goulka is a senior fellow. Every day, nearly 200 people across the country die from drug overdoses.

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Wave of New complex Drugs Flood Emergency Rooms

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Wave of New complex Drugs Flood Emergency Rooms

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Current Event 3

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At a time when drug overdoses are becoming more prevalent and lethal, a new report provides a snapshot of regional illicit drug use and, for the first time, highlights the complexity of detecting and treating patients at hospital emergency departments for a severe drug-related event.

The objective of the study, which began in 2016, was to identify illicit drugs that caused overdoses in patients at two hospital emergency departments in Maryland.

Emergency physicians were battling a spike in accidental drug overdoses and related deaths, thought to be linked to a group of designer drugs called synthetic cannabinoids that mimic the chemicals in marijuana, known on the street as Spice or K2. One doctor described "atypical overdoses," patients with breathing difficulties and constricted pupils who responded well to the opioid overdose-reversing drug naloxone, and then required sedation for acute agitation, violence and hyperactivity, all unrelated to opiate withdrawal.

The physicians believed that knowing which drugs were in use might help tailor patient treatment.

At the same time, researchers at the Center for Substance Abuse Research (CESAR) at the University of Maryland, College Park, with the support of the U.S. Office of National Drug Control Policy, were generating a number of reports detailing illicit drug use patterns in criminal justice settings. The researchers used sophisticated analyses of de-identified urine samples to detect drugs.

The substance abuse researchers decided to expand their urine testing technique for the first time to hospital settings, and link the test results to de-identified patient medical records. Hospitals typically use urine tests to detect just a handful of drugs and medical conditions.

The CESAR researchers enlisted the participation of emergency physicians at the University of Maryland Medical Center Midtown Campus (UMMC Midtown) in Baltimore, and the University of Maryland Prince George's Hospital Center in Cheverly, a suburb of Washington, DC.
Test Results
The urine specimens, 106 from Prince George's and 69 from UMMC Midtown, were sent to the Armed Forces Medical Examiner System laboratory in Delaware where they were tested for 26 synthetic cannabinoids, 59 designer drugs and 84 other illicit and prescription drugs.

With the results, the researchers realized the substances used by these emergency department overdose patients were much more complex than anticipated.

"We were thoroughly amazed that in a study where we thought everyone was having a synthetic cannabinoid-related problem, only one specimen tested positive for synthetic cannabinoids," says principal investigator Eric Wish, PhD, Director of CESAR at the University of Maryland, College Park, College of Behavioral & Social Sciences.

It was clear the street drugs had been tweaked into new combinations that weren't being detected. Still, about a year later, after the lab expanded their tests for synthetic cannabinoids from 26 to 46 metabolites, only a quarter of the samples tested positive for synthetic cannabinoids, much smaller than anticipated.

Also clear was the huge mismatch between the drugs patients said they had taken and physician suspicions of drug use, compared to the actual drugs detected. "We had cases where the doctors thought so, the patient thought so, but urinalysis showed no use of synthetic cannabinoids," says Bradford Schwartz, MD, an emergency physician at the University of Maryland Prince George's Hospital Center and an adjunct assistant professor of emergency medicine at the University of Maryland School of Medicine.

Marijuana was the most common individual drug detected at both hospitals. Moreover, a fifth to a third of specimens at each hospital tested positive for a new psychoactive substance other than synthetic cannabinoids.

Most striking, two-thirds of patients at both hospitals tested positive for multiple substances, and some specimens contained as many as six substances, potentially complicating an overdose diagnosis.
Regional Drug Use Variations
In Baltimore, after marijuana, people tested positive primarily for fentanyl, a highly potent synthetic opioid; in Prince George's County, the drug detected was PCP, an illegal hallucinogenic drug that can trigger aggression and other behavior changes.

The Baltimore region has a long history of opioid-related problems, beginning with heroin, then more recently transitioning to fentanyl and its relatives. At UMMC Midtown, non-fentanyl opioids including morphine and codeine were found in 51 percent of urine samples, while 28 percent tested positive for fentanyl. Midtown emergency physician Zachary D.W. Dezman, MD, says the deaths of nearly 700 people in Baltimore were linked to opioids in 2017.

At UM Prince George's, 47 percent of specimens had PCP and patients were three-to-four times more likely than those at Midtown to show "bizarre or aggressive behavior," according to the physicians.

The study was not designed to determine differences in mortality, but emergency physicians at both hospitals say anecdotally that despite the constantly changing soup of drugs patients take, treating the patient based on their symptoms seemed to work. "These results suggest that supportive care is safe in patients suffering from acute intoxication from synthetic cannabinoids," says Dr. Dezman, also an assistant professor of emergency medicine at the University of Maryland School of Medicine.

The addition of fentanyl screening to the standard drug tests used in hospitals would be useful, Dr. Dezman says. While the results of the urine drug screen are not critical to the patient's emergency care, "it is important to inform patients of the risks of their substance use once they are stabilized." He says a number of patients have requested substance abuse treatment once they learned they had inadvertently used fentanyl. As well, he says hospital testing could illuminate the bigger fentanyl picture. "Policy makers and public health officials cannot make informed policy decisions about combating fentanyl if we do not know the prevalence of fentanyl use in the community."

"This report underscores one of the benefits of cross-campus collaboration to harness research and clinical synergies that translate to improved patient care," says E. Albert Reece, MD, PhD, MBA, executive vice president for medical affairs at the University of Maryland, the John Z. and Akiko K. Bowers Distinguished Professor and dean of the University of Maryland School of Medicine.

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today's healthcare; controlled substances; pharmacology; addiction; illegal drugs; opium; public health; educational policy; disaster plan

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New wave of complex street drugs puzzles emergency doctors: Study may fuel need for more comprehensive drug testing in hospitals

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At a time when drug overdoses are becoming more prevalent and lethal, a new report provides a snapshot of regional illicit drug use and, for the first time, highlights the complexity of detecting and treating patients at hospital emergency departments for a severe drug-related event.

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Journal 3

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Worgul, Sarna & Ness, Criminal Defense Attorneys, LLC

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The U.S. Controlled Substances Act breaks downregulated drugs into five schedules based on their potential for addiction and abuse. Drugs that fall into these classifications are known as controlled substances and if you are caught possessing, distributing, selling or manufacturing them, you can be prosecuted under both federal and Pennsylvania laws.

Schedule I drugs are the most dangerous and Schedule V drugs are the least. If your drug arrest involves Schedule I or Schedule II drugs, you have an increased chance of being charged with a felony offense. If you are found guilty, you can be sentenced based on Pennsylvania's mandatory minimum sentencing laws that apply to all scheduled drugs. If you or a family member is charged with a Schedule I or II drug crime, it is critical that you retain a defense attorney who thoroughly understands drug laws.

We are available to answer your calls and defend your rights. Call us today for a free consultation: .

Schedule I Drugs

Schedule 1 drugs are classified as the most likely to cause potentially severe physical or psychological dependence. They have the highest potential to be abused and no legitimate medical use in the U.S. They include heroin, marijuana, LSD, MDMA, and peyote.

Schedule II Drugs

Schedule II drugs also have a high potential for abuse, although less than Schedule I drugs, and they can cause physical or psychological dependence. Schedule II drugs do have medical use in the U.S. and are available by prescription. They include OxyContin, methamphetamine, methadone, Percocet, cocaine, Demerol, fentanyl, Ritalin, and Adderall.

Penalties for Schedule I & II Drugs

For the first offense of possession of an illegal substance, you can face up to a year in jail and/or a fine up to $5,000.

With any Schedule I or II-related conviction, your driver's license will be suspended for six months for a first offense, one year for a second offense, and two years for a third offense.

You will likely also see an effect on other areas of your life if you're convicted of a drug crime, like difficulty getting a job, trouble maintaining your current job, loss of custodial rights if you have children and more.

Proving Possession

In Pennsylvania, you have possession of a controlled substance when you own or possess it. If the controlled substance is available by prescription, and you are caught with the drug but without a valid prescription for it, you can be charged. For you to be convicted of possessing a controlled substance, prosecutors must prove:

You knowingly and intentionally had control of an illegal drug.

You knew the drugs were illegal, you knew the drugs were present, and you intended to use or control them.

You either had actual or constructive possession of a controlled substance. In other words, you had the drug on your person, such as in your pocket, or in a spot that you had control over, like the trunk of your car or hidden under your bed.

Selling or Intending to Sell a Schedule I or II Drug

If you are caught with a controlled substance in your possession, the courts in Pennsylvania can punish you harshly. But if you are arrested for selling, or intending to sell, those same drugs, the penalties you face will be even more severe.

The penalties for selling Schedule I or II drugs are the harshest of any classification of controlled substances.

If you are charged with selling or intending to sell a Schedule I or II drug you risk being sentenced to as many as 15 years in prison and a fine of up to $250,000.

In Pennsylvania, the judge will use the specific circumstances of your case as part of the equation when he or she determines your sentence. You can receive heavier penalties based on factors such as drug amount, weapons involvement, prior convictions and whether you were arrested near a school.

What Pennsylvania Law Says About Drugs

Pennsylvania covers laws pertaining to drugs under the Pennsylvania Code, Title 35. Under the Controlled Substance, Drug, Device and Cosmetic Act, it is prohibited to knowingly or intentionally possess drugs (or fake drugs) unless you have a prescription. It is also prohibited to manufacture, deliver, or possess with the intent to deliver drugs unless you are licensed to do so. A violation of the former is a misdemeanor while a violation of the latter is a felony. Mandatory minimum sentencing does apply.

Steps To Take If You Have Been Charged

If you have been charged with a drug offense, your first step should be to immediately hire a lawyer.

An experienced drug attorney will have worked with the prosecutors handling your case many times before. They can draw on their relationships and understanding of the local court system to lessen or dismiss your charges.

Don't talk to the police or prosecutors unless your attorney is with you.

Your lawyer will go over what happened both before and after your arrest. Importantly, he or she will assess whether there was probable cause to charge you with a crime. This includes determining if the drugs really belonged to you.

If you were arrested for a drug crime while you were in your car, a critical aspect of your case will be whether or not the police had probable cause to pull you over and do a search. If there was not probable cause, the evidence obtained by law enforcement can be suppressed.

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Schedule I & II Drugs And Penalties | Worgul, Sarna & Ness, Criminal Defense Attorneys

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The U.S. Controlled Substances Act breaks downregulated drugs into five schedules based on their potential for addiction and abuse. Drugs that fall into these classifications are known as controlled substances and if you are caught possessing, distributing, selling or manufacturing them, you can be prosecuted under both federal and Pennsylvania laws.

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What is the problem?

The World Health Organization (WHO) estimates that tobacco is the largest cause of preventable death in the world. Smoking is responsible for almost 6 million deaths each year or the loss of 140 million years of healthy life, with nearly 80% of the burden falling on low- and middle- income countries (LMIC), a burden amounting to more than malaria and HIV combined. Each death as a result of pack-a-day smoking shortens life by around 10 years, as shown by data in the United States.

Collectively, smoking is responsible for 5-6% of all ill health globally according to the Global Burden of Disease study, and its share is rising over time.

Why is this problem pressing?

What is our recommendation based on?

Many in the development and public health fields see the problem as an effective intervention for improving health. Reviews by global health charity evaluators and foundations The Open Philanthropy Project, Giving What We Can, Copenhagen Consensus and the Centre for Global Development (CGD) were mostly positive that tobacco control is a cost-effective public health intervention, with CGD calling tobacco taxes "The Single Best Health Policy in the World". This page is largely based on their research.

That the Gates Foundation, has committed US$125 million over 5 years, and the Bloomberg Foundation has committed US$220 million over 4 years provides confidence that respected philanthropists see this as a pressing issue.

Why is it pressing?

Tobacco use is increasing in low- and middle-income countries and if no action is taken, the number of annual tobacco deaths is projected to rise to more than 8 million by 2030, amounting to the loss of more than 200 million years of healthy life. The Copenhagen Consensus Centre researchers estimate a total economic loss from tobacco of about 12.7 trillion dollars over the next 20 years - or about 1.3% of global GDP annually - as a result of tobacco causing one-third of deaths from vascular disease, half the cancers and 60% of chronic respiratory diseases.

Furthermore, it is clear how tobacco use can be reduced, and many countries have succeeded in significantly reducing smoking rates. Taxing tobacco products seems to reduce consumption by about 4% for every 10% increase in price. Such a policy also costs the government nothing - rather it raises revenue. The main limiting factor is political enthusiasm for policies of this kind, which may be resisted by tobacco companies, smokers themselves and those who oppose interfering with people's choice to smoke.

Despite the above, many developing countries do not have effective anti-tobacco programs. For example, The WHO Global Adult Tobacco Survey for China showed that only 23% of Chinese adults knew that smoking caused lung cancer, heart attacks and strokes. The taxation share of the cost of a pack of cigarettes in China is also only 40%, significantly lower than in most developed countries and the level recommended by the WHO (75%).

Efforts we could identify to discourage smoking amount to less than $1 per smoker in the developing world per year.

What are the major arguments against it being pressing?

Tobacco companies will resist attempts to regulate cigarettes, making lobbying efforts challenging.

There are already substantial efforts being made by some funders and public health experts to solve this problem (see "Who else is working on this problem?").

Some believe it is undesirably paternalistic to prevent people from smoking if they choose to do so, or even that it is rational to smoke given the enjoyment people get from it.

In practice it may not be practical for our mostly English-speaking readers to influence tobacco policy in countries like China, where most of the growth in smoking is occurring. China is particularly interesting because all tobacco is sold by the government, and smoking accounts for 7-10% of central government revenue, suggesting there will be many interest groups to compete with on the issue.

It might turn out that improving health does not much affect the long term progress or direction of human civilization, making it less important than it would seem based on its short term effect on welfare.

Key judgement calls made to prioritise this problem

Attempts to get policy change that discourages tobacco smoking will sometimes work at a reasonable cost.

It is good to discourage people from smoking, because the health damage exceeds any gain people get from enjoying smoking.

There are developing countries available that would listen to external experts to help them set tobacco control policies.

What can you do about this problem?

What's most needed to contribute to this problem?

Most methods for reducing tobacco deaths are relatively well known and have been tested in developed countries. For example, the 'MPOWER' package of policies developed by the World Health Organisation recommends the following:

Monitor tobacco use and prevention policies

Protect people from secondhand tobacco smoke

Offer help to quit tobacco use

Warn about the dangers of tobacco

Enforce bans on tobacco advertising, promotion and sponsorship

Raise taxes on tobacco.

This approach and the likely impacts is described in detail in a recent WHO report.

Promotion of electronic cigarettes is a new and potentially valuable way of helping people quit smoking, though controversial.

As a result of the fact that the interventions are quite well studied and unlikely to be dramatically improved, implementation seems to be the key issue. This means designing and advocating for better government policy through public service, academia, think tanks and political parties.

Given the significant amounts of funding that have recently been made available (see 'Who is working on this problem, below), this area is more likely talent constrained.

What skill sets and resources are most needed?

People with experience in:

Health and economic policy

Knowledge of appropriate policy responses

Influence to implement or promote changes

Public health
Improving our knowledge of the effectiveness, and cost-effectiveness of each intervention to reduce tobacco consumption

Who is working on this problem?

National governments, in particular health departments, many of whom have programs to discourage smoking.

The World Health Organization provides support to countries that want to reduce tobacco use.

A pair of foundations also provide significant support:

Including academics and public servants working on tobacco control along with philanthropic giving, we estimate that the resources going directly towards anti-smoking efforts are between US$100 - US$1,000 million per year.

In considering how neglected the cause is, we should not forget supporters in the general public, who discourage people from smoking or vote in support of voting cessation policies, though we are not sure how to value them.

What can you concretely do to help?

Complete graduate studies in policy, public health, evidence based social policy or economics.

Conduct academic research into finding the most effective and cost-effective tobacco control policies; or study how those policies can be promoted in countries that do not yet have them.

Apply to work at one of these organisations:

Gates Foundation

Bloomberg Foundation

World Lung Foundation

Campaign for Tobacco-Free Kids

World Health Organization

Centers for Disease Control and Prevention Foundation

Johns Hopkins Bloomberg School of Public Health

A wide range of positions with a public platform can be applied part time to the problem of tobacco control. For example, someone could use their skills as:

a journalist to report on tobacco as a public health issue and to push for enforcement of adopted policies, or to help other journalists do so;

an academic or other researcher could write up policy proposals for a think tank;

a politician to push for evidence based tobacco reduction or cessation policies; or

a grassroots activist to raise the level of attention devoted to tobacco use.

These kinds of activism are particularly promising if you already have local experience in a poorer country that has high smoking rates. If you are in a position to do these things soon you could apply for a grant from the foundations listed above.

Finally, someone could earn to give and themselves donate to anti-tobacco organisations or campaigns. We have not investigated opportunities for philanthropy in this area, but some charities do accept donations, such as the Campaign for Tobacco-Free Kids. One could also simply donate to whichever projects the larger foundations in this area make grants to.

Further reading

Want to work on this problem?

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Or join our newsletter and get notified when we release new problem profiles.

Notes and references

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Why smoking in the developing world is an enormous problem and how you can help save lives

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Smoking takes an enormous toll on human health - accounting for about 6% of all ill-health globally according to the best estimates. This is more than HIV and malaria combined. Despite this, smoking is on the rise in many developing countries as people become richer and can afford to buy cigarettes.

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CLOSE

It's impossible to talk about the opioid epidemic without talking about doctors.

More and more physicians are owning up to the role they played in prescribing highly addictive painkillers, peddled by drug companies as safe, to millions of Americans - eventually leaving some with a raging addiction.

And when heroin costs $5 a bag, the transition from prescribed pills to a white, powdery street drug becomes a lot easier.

The epidemic is one that officials from nearly every sector are trying to fight, as a public health crisis claiming more lives than the Vietnam War ever did continues to strip agencies of millions of dollars.

Last week, Michigan doctors fighting to change prescribing habits shared some of their success stories with physicians at Christiana Care Health System. Here were some of the highlights - and what Christiana is already doing to help.

Opioid prescriptions still flowing from dentists

Nearly 80 percent of people aged 13 to 30 were prescribed an opioid when they had their wisdom teeth removed, according to a study that examined dentistry data from July 2009 to December 2015.

Buy Photo

Doctors from the University of Michigan presented new data to doctors at Christiana Care Wednesday in hopes of changing the tide of the addiction epidemic. (Photo: Brittany Horn/The News Journal)

This prescription increased the likelihood of a person becoming addicted to those drugs 3½ times more than a person never exposed to opioids, said Dr. Chad Brummett. He's an associate professor with the University of Michigan Medical School and co-director of the Michigan Opioid Prescribing Engagement Network.

And dentists continue to prescribe high numbers of opioids, especially when it comes to oral surgery, Brummett said.

DELAWARE'S DEADLY CRISIS

What heroin costs Delaware - in lives and money

Heroin epidemic moves into Delaware's small towns and swamps police

Opioids don't equal patient satisfaction

Contrary to popular belief, Brummett said the amount of opioids prescribed after surgery is not associated with patient satisfaction or prescription refill rate.

In fact, studies show that the less opioids patients are prescribed, the less they will end up taking - which Brummett hopes will encourage doctors to prescribe less in the first place.

"We need to prescribe for just enough rather than just in case," said Dr. Matt Powell, an anesthesiologist at Christiana Care. (Photo: BackyardProduction, Getty Images/iStockphoto)

"I don't usually start my day with a chocolate croissant, but if you put it out there, I might eat it," Brummett said, acknowledging that putting more opioids into the hands of patients only ups the availability to the average person.

The state of Michigan is also working with insurance providers to create monetary incentives for prescribing less or no opioids at all after specific procedures. Delaware currently does not offer those incentives.

Less exposure to opioids is better for the entire society, Brummett said.

"We really need to think about keeping healthy people healthy," he said.

What Christiana Care is doing

Dr. Matt Powell, an anesthesiologist at Christiana Care who is leading Delaware's version of the Opioid Prescribing Engagement Network, said physicians in Delaware - and nationwide - know they're over-prescribing, but need guidance on how to successfully change those habits.

"We're spending all the money on treatment," he said, "but we have to cut off the supply."

In 2012, Delaware led the nation as the No. 1 prescriber of high-dose opioids. Now, the state is losing about one person a day to suspected drug overdoses. The two situations share a link that Christiana Care wants to help prevent.

From July 2017 to July 2018, the hospital reported a 40 percent reduction in opioids prescribed to patients, which Christiana Care attributes to surgical procedures. The hospital system says this is a direct result of new guidelines created by Delaware OPEN.

Christiana Care also reported:

A 40 percent reduction in the number of opioids prescribed after some ob-gyn and general surgery procedures.

A reduction by almost 50 percent in the rate of opioid prescriptions among discharged emergency department patients.

A 37 percent reduction in the number of primary care patients on chronic opioid therapy for pain in a pilot project at the Rocco A. Abessinio Family Wilmington Health Center at Wilmington Hospital.

Powell said the results show that prescribing fewer opioids is possible - and so is the mindset shift that comes with it.

"We need to prescribe for just enough rather than just in case," Powell said.

PERSONAL BATTLES WITH ADDICTION

Buried in her senior prom dress, Delaware woman falls victim to heroin's grips

Delaware shocked heroin took an addiction champion

In Delaware, the race against addiction grows
Contact Brittany Horn at (302) 324-2771 or bhorn@delawareonline.com. Follow her on Twitter at @brittanyhorn.
Read or Share this story: https://www.delawareonline.com/story/news/local/heroindelaware/2018/08/20/prescribing-fewer-opioids-doctors-hope-slow-addiction-epidemic/1010160002/

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By prescribing fewer opioids, doctors hope to slow addiction epidemic

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CLOSE It's impossible to talk about the opioid epidemic without talking about doctors. More and more physicians are owning up to the role they played in prescribing highly addictive painkillers, peddled by drug companies as safe, to millions of Americans - eventually leaving some with a raging addiction.

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Synthetic Marijuana

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Over the course of two days in mid-August, more than 95 people in New Haven, Connecticut, overdosed.

Their drug, however, wasn't heroin. It was synthetic cannabinoids, commonly sold as K2, Spice, or potpourri.

The fallout from the incident was so widespread that experts have referred to it as a " mass casualty incident."

More than that, it has become a symbol of the dangers of a class of drugs that officials in the United States have little understanding of and even less control over.

In nearby Baltimore, a new study by the University of Maryland's Center for Substance Abuse Research (CESAR) published this month articulates many of the problems with identifying and treating synthetic cannabinoid overdoses.
NEBRASKA MAN CLAIMS MISSED WEST NILE DIAGNOSIS LEFT HIM PARALYZED
Researchers studied urine samples of patients with suspected synthetic cannabinoid overdose at two different hospitals, the University of Maryland Medical Center Midtown Campus in Baltimore and the University of Maryland Prince George's Hospital Center in Cheverly, a suburb of Washington, D.C.

They almost immediately hit a snag with their study.

If the patients had been using Spice, why wasn't it showing up in their urine?

"When we got the results back, it was just kind of amazing because we expected to find a large percentage testing positive for the synthetic cannabinoids metabolites we were testing for, and what we found was that in the first go around only I think one specimen testing positive for it," said principal investigator Eric Wish, PhD, a principal study investigator and director of CESAR at the University of Maryland, College Park, College of Behavioral & Social Sciences.

Despite testing the urine for 169 different drugs, including 26 metabolites of synthetic cannabinoids, it simply wasn't there.

The issue, say experts, highlights an urgent need for improved testing for so-called new psychoactive substances, including Spice and synthetic cathinones, also known as bath salts.

These new drugs don't show up on standard drug tests, making it difficult to form a clear diagnosis.
GIRL, 4, CONTRACTS LIFE-THREATENING INFECTION AFTER TRYING ON SHOES WITHOUT SOCKS, MOM CLAIMS
Designer drugs continually manage to dodge legislation because whenever a certain variety is outlawed based on its chemical structure, a new similar chemical is manufactured and sold legally.

"While the press and the media talk about Spice and K2 like it's a single type of phenomenon, the truth can't be further from that," Wish told Healthline. "Basically what you have is some chemist in another country, oftentimes the DEA says it's China, who waits and they see what has been put on the prohibited list by the government. And then they go ahead and they tweak the molecule a little so it's no longer on the prohibited list and then they make it available."

New diagnostic measures

One year later, researchers implemented an updated drug-test panel that increased the number of synthetic cannabinoids from 26 to 46.

Even with this improved panel, only about one-quarter of the samples tested positive.

The study also highlights several other findings that could potentially help improve immediate care for individuals overdosing on newer drugs at emergency departments as well as future public health initiatives.

For instance, where a patient lives can foretell what drugs may be in their bloodstream.

Researchers saw that in patients at Prince George's County. Nearly half of them also tested positive for the hallucinogen PCP.

Those at the Midtown Campus hospital were far more likely to have cocaine and fentanyl in their bloodstream.

"The study provides public health officials, provides patients themselves, an understanding of the risks that they are exposed to," said Dr. Zachary D.W. Dezman, an assistant professor of emergency medicine at the University of Maryland School of Medicine.

The fentanyl factor

Fentanyl, a powerful synthetic opioid, is increasingly showing up across the United States with deadly results.

In this study, researchers found that among all substances, fentanyl was the most likely to be found in combination with multiple other drugs.

In some specimens, it was detected with as many as 12 others - indicating that users either aren't aware what is in their drugs or that users of fentanyl are regularly using many different drugs simultaneously.

People "want to know what they've been exposed to," said Dezman.
OREGON FIREFIGHTER DIES AFTER SUFFERING 'IRREVERSIBLE' DAMAGE TO ORGANS WHILE BATTLING WILDFIRES, FAMILY SAYS
"I've had a number of patients who once they were told they were fentanyl positive... started to seek treatment," he added.

Such is the deadly reputation of that drug.

Currently, fentanyl doesn't show up on common "dip tests" used in hospitals, but Dezman hopes that will soon change.

Synthetic cannabinoids, fentanyl, and synthetic cathinones represent a new challenge for members in the healthcare community to identify and treat, but by understanding which drugs are being used in which communities, better education and treatment options can be developed.

"We can track people down to a particular area code, and that allows us to do things like create, potentially, a mobile van for education efforts to educate the neighborhood on the dangers they are being exposed to, signs to look out for an opioid overdose, distribute naloxone, and potentially also start a mobile opioid maintenance therapy van [to provide] methadone or Suboxone," said Dezman.
This article first appeared on HealthLine.com.

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New synthetic drug strains are making it difficult to diagnose overdoses

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Over the course of two days in mid-August, more than 95 people in New Haven, Connecticut, overdosed. Their drug, however, wasn't heroin. It was synthetic cannabinoids, commonly sold as K2, Spice, or potpourri. The fallout from the incident was so widespread that experts have referred to it as a " mass casualty incident."

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Journal 2

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Most Doctors Are Ill-Equipped to Deal with the Opioid Epidemic. Few Medical Schools Teach Addiction

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Most Doctors Are Ill-Equipped to Deal with the Opioid Epidemic. Few Medical Schools Teach Addiction

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Matthew DeFazio, center, a medical student at Boston University, asks a fictional patient, portrayed by Ric Mauré, right, about his drug use. Dr. Bradley M. Buchheit coaches. Credit Credit Kayana Szymczak for The New York Times

BOSTON - To the medical students, the patient was a conundrum.

According to his chart, he had residual pain from a leg injury sustained while working on a train track. Now he wanted an opioid stronger than the Percocet he'd been prescribed. So why did his urine test positive for two other drugs - cocaine and hydromorphone, a powerful opioid that doctors had not ordered?

It was up to Clark Yin, 29, to figure out what was really going on with Chris McQ, 58 - as seven other third-year medical students and two instructors watched.

"How are you going to have a conversation around the patient's positive tox screen results?" asked Dr. Lidya H. Wlasiuk, who teaches addiction awareness and interventions here at Boston University School of Medicine.

Mr. Yin threw up his hands. "I have no idea," he admitted.

Chris McQ is a fictional case study created by Dr. Wlasiuk, brought to life for this class by Ric Mauré, a keyboard player who also works as a standardized patient - trained to represent a real patient, to help medical students practice diagnostic and communication skills. The assignment today: grappling with the delicate art and science of managing a chronic pain patient who might be tipping into a substance use disorder.

How can a doctor win over a patient who fears being judged? How to determine whether the patient's demand for opioids is a response to dependence or pain?

Addressing these quandaries might seem fundamental in medical training - such patients appear in just about every field, from internal medicine to orthopedics to cardiology. The need for front-line intervention is dire: primary care providers like Dr. Wlasiuk, who practices family medicine in a Boston community clinic, routinely encounter these patients but often lack the expertise to prevent, diagnose and treat addiction.

According to the Centers for Disease Control and Prevention, addiction - whether to tobacco, alcohol or other drugs - is a disease that contributes to 632,000 deaths in the United States annually.

But comprehensive addiction training is rare in American medical education. A report by the National Center on Addiction and Substance Abuse at Columbia University called out "the failure of the medical profession at every level - in medical school, residency training, continuing education and in practice" to adequately address addiction.

Dr. Timothy Brennan, who directs an addiction medicine fellowship at Mount Sinai Health System, said that combating the crisis with this provider work force is "like trying to fight World War II with only the Coast Guard."

Now, a decade-long push by doctors, medical students and patients to legitimize addiction medicine is resulting in blips of change around the country. A handful of students has begun to specialize in the nascent field, which concentrates on prevention and treatment of addictions and the effect of addictive substances on other medical conditions. In June, the House of Representatives authorized a bill to reimburse education costs for providers who work in areas particularly afflicted by addiction.

There are only 52 addiction medicine fellowships (addiction psychiatry is a separate discipline), minuscule compared to other subspecialties. In August, the first dozen finally received gold-standard board certification status from the Accreditation Council for Graduate Medical Education (by contrast, there are at least 235 accredited programs in sports medicine).

While most medical schools now offer some education about opioids, only about 15 of 180 American programs teach addiction as including alcohol, tobacco and other drugs, according to Dr. Kevin Kunz, executive vice president of the Addiction Medicine Foundation, which presses for professionalization of the subspecialty. And the content in all schools varies, he noted, ranging from one pharmacology lecture to several weeks during a third-year clinical rotation, usually in psychiatry or family medicine.

Programs rarely go deeper. But Boston University braids addiction training into all four years.

This 75-minute session to teach B.U. students the nuances of assessing a pain patient is already unusual. What also distinguishes it is the presence of an addiction medicine fellow, Dr. Bradley M. Buchheit of Boston Medical Center.

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Dr. Lidya Wlasiuk, third from right, teaches medical students how to treat patients with addictions respectfully. "Language matters," she said. "Avoid saying, 'I found this out.' Instead, say, 'This was in your urine screen.' You want to keep that conversation going, not shut it down." Credit Kayana Szymczak for The New York Times

"What isn't present in his tox screen?" Dr. Buchheit prompted students.

Fidgety silence.

"What we've prescribed him - Percocet," Dr. Buchheit told them.

"So we have to figure out where that Percocet has been going."

And suddenly the medical maze surrounding Mr. McQ became even more complex.

Asking about cocaine use

When you are a twenty-something medical student, fists clenching nervously in the pockets of your white medical coat, learning to get gruff, grizzled Chris McQ to disclose uncomfortable truths is not readily gleaned from a textbook. Mr. McQ is crusty and defensive. As students resorted to the same chirpy rejoinder - "Awesome!"- he tried not to flinch. The man just wanted pain meds.

In each small-group session, a student had 15 minutes to assess Mr. McQ and make a plan. Mr. McQ once had a cocaine problem. His girlfriend was taking hydromorphone, known as Dilaudid, for back pain. Was he at risk for misusing opioids?

"Ask him about his pain first," Dr. Wlasiuk told the students. "Language matters. Avoid saying, 'I found this out.' Instead, say, 'This was in your urine screen.' You want to keep that conversation going, not shut it down."

The students had learned about "motivational interviewing," a technique that encourages patients to articulate health goals. As medicine moves away from doctor-knows-best paternalism, students are being schooled in engaging the patient with a joint-decision-making, team approach.

Before Mr. McQ entered the classroom, the students debated: Was he selling Percocet to buy cocaine? Stealing his girlfriend's Dilaudid?

Dr. Buchheit cautioned: "Substance use disorder is a chronic, relapsing disease. So is diabetes. Diabetics don't follow a diabetic diet 100 percent of the time. If they were to have a slip-up, we would figure out what went wrong and say 'Is there anything else we can do?'"

Despite the urgent need for addiction medicine education, there are considerable barriers to establishing it. Hours of training have already been meted out to conditions deemed critical. Making time in a jammed schedule can mean another subject has to be shrunk.

Because addiction medicine is young, most medical schools can't rely for expertise on fellows - post-graduate students who steep themselves in a subspecialty. Fellows would typically consult on addiction-related cases in hospitals and clinics, educate medical students and supervise residents in primary care fields where these patients first appear: family medicine, emergency medicine, obstetrics.

And so the field of addiction medicine struggles to perpetuate itself.

Dr. Daniel Alford, a professor and associate dean at Boston University, is a driving force behind its curriculum. "The biggest challenge now is how do you sustain it?" he said. "Who keeps updating it? When faculty leave, who will replace them?"

There is not much incentive to specialize in addiction medicine. According to a 2017 study, insurance disparities can be striking. Insurance views addiction treatment as an afterthought to mental health therapy, which itself trails reimbursement for physical health care.

The reasons for resisting this career are also cultural. The stigma that attaches to patients also clings to doctors who treat them. The patients are often dismissed as manipulative and incurable; caring for them is seen as a thankless endeavor.

At a South Boston community health center, Chioma Anyikwa (left), a medical student, counsels a patient, Sharon, who is in recovery from opioids. Credit Kayana Szymczak for The New York Times

"I really enjoy working with these patients," Dr. Buchheit told the students. "They have often been kicked to the curb by the formal medical system. They don't trust us. So for them to walk into a room and have a doctor say, 'It's great to see you, thank you for coming in,' is very powerful. And then you can see them get better with treatment. It can be very rewarding work."

The students tried out approaches on Mr. McQ. "You called our office and wanted an early refill on your Percocet," said one. "But it's important that you come in. I'm glad you're here and we can maintain our relationship."

Mr. McQ told one student that his pain had worsened - that he ran through his prescription, tried to get more and took some of his girlfriend's Dilaudid.

Mr. McQ suggested that the doctor switch him to Dilaudid.

"Time out!" Mr. Yin, the student, said, turning to the class.

"What are you struggling with?" Dr. Wlasiuk asked him.

Mr. Yin replied that he didn't want to reward the patient's behavior with a prescription for stronger medication, but also didn't want to drive the patient away. "I trust the patient's story about pain," he said, "but I don't want to be naïve."

Another student asked: "By increasing his dose, are you protecting him from getting the drugs off the street?"

Dr. Wlasiuk said that although medical training typically urges students to come up with absolute answers, treating these patients often means getting comfortable with ambiguity.

The students brainstormed with her and Dr. Buchheit. Some offered to raise the Percocet dose if he agreed to frequent office visits; others urged him to try physical therapy and acupuncture.

A few remembered to caution Mr. McQ about opioids. ("Percocet is an opioid?" Mr. McQ responded. "I'm not one of those people!")

In an evenhanded tone, Chioma Anyikwa, 25, marched through Mr. McQ's history and pain, which he had previously listed as four of 10.

"A seven-plus," he said.

"Wow, that's pretty high," she said. "Did you do anything else to treat it?" Hesitantly, he spoke about sharing his girlfriend's Dilaudid.

"In your urine screen we also saw some cocaine," she continued. "Do you know anything about that? I appreciate you being honest with me."

Mr. McQ looked uneasy. "It's not gonna mess me up if I tell you?"

She shook her head. "No, we just want to help you regroup and fix the problem," she said.

Dr. Wlasiuk with Ms. Anyikwa and a patient, Brooke Anglin, during a checkup. "I am amazed by your strength," Dr. Wlasiuk said. Credit Kayana Szymczak for The New York Times

He admitted that a friend had been in town and they did a few lines for old times' sake.

Afterward, Ms. Anyikwa braced for the group's feedback.

"Did I talk too much?" she asked.

From classroom to clinic

Two days later, Ms. Anyikwa screened actual patients.

Supervised by Dr. Wlasiuk, she spent a day at South Boston Community Health Center.

The first patient, Brooke Anglin, 28, had had a rough ride. During a turbulent relationship when she was sagged down by depression and severe anxiety, she soothed herself with opioids. After the birth of her second child, she lost both her job as a supermarket cake decorator and custody of her two children. Under Dr. Wlasiuk's care, she gradually weaned herself off the opioids.

As Dr. Wlasiuk looked on, Ms. Anyikwa began careful questioning. "How have things been going?" she asked the patient.

Not great, Ms. Anglin replied. Earlier that week she had been evicted.

"That's a lot," Ms. Anyikwa responded. "How are you coping?"

Ms. Anglin said she'd had a resurgence of anxiety.

That was enough for Dr. Wlasiuk to step in. "Is your heart racing? Are you feeling panicky?"

Ms. Anyikwa watched Dr. Wlasiuk closely.

"Have you felt you wanted something for it from your friends?" Dr. Wlasiuk gently pressed. "What's stopped you?"

Ms. Anglin whispered, "I want my kids back."

Dr. Wlasiuk grasped Ms. Anglin's hands. "I am amazed by your strength," she said. "I want to treat your anxiety until things settle down. What are your thoughts?"

They agreed on temporary anti-anxiety medication. Dr. Wlasiuk also taught her breathing exercises.

After the patient left, Dr. Wlasiuk remarked, "Primary care is the right place for treating substance misuse. We have the privilege of getting to know our patients well. How can you treat addiction in a vacuum?"

The next up was Sharon, 61, who brought along a toddler grandchild. Both Sharon and her daughter, the child's mother, take Suboxone, a medication that can ease opioid craving.

Dr. Wlasiuk entered and Ms. Anyikwa started her recitation.

"Sharon has been clean for years," Ms. Anyikwa began.

Vigilant about language and stigma, Dr. Wlasiuk interrupted her. "Clean" is eschewed by many in the field, because it implies that those in the throes of addiction are, by extension, "dirty."

Educating new practitioners requires painstaking deconstruction of old reflexive thinking, careful building of fresh approaches.

"You mean she's in recovery," Dr. Wlasiuk quietly admonished Ms. Anyikwa.

"Right," the student replied, abashed. "In recovery."

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Most Doctors Are Ill-Equipped to Deal With the Opioid Epidemic. Few Medical Schools Teach Addiction.

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BOSTON - To the medical students, the patient was a conundrum. According to his chart, he had residual pain from a leg injury sustained while working on a train track. Now he wanted an opioid stronger than the Percocet he'd been prescribed.

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http://www.foxnews.com/health/2018/09/04/new-synthetic-drug-strains-are-making-it-difficult-to-diagnose-overdoses.html

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Over the course of two days in mid-August, more than 95 people in New Haven, Connecticut, overdosed.

Their drug, however, wasn't heroin. It was synthetic cannabinoids, commonly sold as K2, Spice, or potpourri.

The fallout from the incident was so widespread that experts have referred to it as a " mass casualty incident."

More than that, it has become a symbol of the dangers of a class of drugs that officials in the United States have little understanding of and even less control over.

In nearby Baltimore, a new study by the University of Maryland's Center for Substance Abuse Research (CESAR) published this month articulates many of the problems with identifying and treating synthetic cannabinoid overdoses.
NEBRASKA MAN CLAIMS MISSED WEST NILE DIAGNOSIS LEFT HIM PARALYZED
Researchers studied urine samples of patients with suspected synthetic cannabinoid overdose at two different hospitals, the University of Maryland Medical Center Midtown Campus in Baltimore and the University of Maryland Prince George's Hospital Center in Cheverly, a suburb of Washington, D.C.

They almost immediately hit a snag with their study.

If the patients had been using Spice, why wasn't it showing up in their urine?

"When we got the results back, it was just kind of amazing because we expected to find a large percentage testing positive for the synthetic cannabinoids metabolites we were testing for, and what we found was that in the first go around only I think one specimen testing positive for it," said principal investigator Eric Wish, PhD, a principal study investigator and director of CESAR at the University of Maryland, College Park, College of Behavioral & Social Sciences.

Despite testing the urine for 169 different drugs, including 26 metabolites of synthetic cannabinoids, it simply wasn't there.

The issue, say experts, highlights an urgent need for improved testing for so-called new psychoactive substances, including Spice and synthetic cathinones, also known as bath salts.

These new drugs don't show up on standard drug tests, making it difficult to form a clear diagnosis.
GIRL, 4, CONTRACTS LIFE-THREATENING INFECTION AFTER TRYING ON SHOES WITHOUT SOCKS, MOM CLAIMS
Designer drugs continually manage to dodge legislation because whenever a certain variety is outlawed based on its chemical structure, a new similar chemical is manufactured and sold legally.

"While the press and the media talk about Spice and K2 like it's a single type of phenomenon, the truth can't be further from that," Wish told Healthline. "Basically what you have is some chemist in another country, oftentimes the DEA says it's China, who waits and they see what has been put on the prohibited list by the government. And then they go ahead and they tweak the molecule a little so it's no longer on the prohibited list and then they make it available."

New diagnostic measures

One year later, researchers implemented an updated drug-test panel that increased the number of synthetic cannabinoids from 26 to 46.

Even with this improved panel, only about one-quarter of the samples tested positive.

The study also highlights several other findings that could potentially help improve immediate care for individuals overdosing on newer drugs at emergency departments as well as future public health initiatives.

For instance, where a patient lives can foretell what drugs may be in their bloodstream.

Researchers saw that in patients at Prince George's County. Nearly half of them also tested positive for the hallucinogen PCP.

Those at the Midtown Campus hospital were far more likely to have cocaine and fentanyl in their bloodstream.

"The study provides public health officials, provides patients themselves, an understanding of the risks that they are exposed to," said Dr. Zachary D.W. Dezman, an assistant professor of emergency medicine at the University of Maryland School of Medicine.

The fentanyl factor

Fentanyl, a powerful synthetic opioid, is increasingly showing up across the United States with deadly results.

In this study, researchers found that among all substances, fentanyl was the most likely to be found in combination with multiple other drugs.

In some specimens, it was detected with as many as 12 others - indicating that users either aren't aware what is in their drugs or that users of fentanyl are regularly using many different drugs simultaneously.

People "want to know what they've been exposed to," said Dezman.
OREGON FIREFIGHTER DIES AFTER SUFFERING 'IRREVERSIBLE' DAMAGE TO ORGANS WHILE BATTLING WILDFIRES, FAMILY SAYS
"I've had a number of patients who once they were told they were fentanyl positive... started to seek treatment," he added.

Such is the deadly reputation of that drug.

Currently, fentanyl doesn't show up on common "dip tests" used in hospitals, but Dezman hopes that will soon change.

Synthetic cannabinoids, fentanyl, and synthetic cathinones represent a new challenge for members in the healthcare community to identify and treat, but by understanding which drugs are being used in which communities, better education and treatment options can be developed.

"We can track people down to a particular area code, and that allows us to do things like create, potentially, a mobile van for education efforts to educate the neighborhood on the dangers they are being exposed to, signs to look out for an opioid overdose, distribute naloxone, and potentially also start a mobile opioid maintenance therapy van [to provide] methadone or Suboxone," said Dezman.
This article first appeared on HealthLine.com.

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New synthetic drug strains are making it difficult to diagnose overdoses

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Over the course of two days in mid-August, more than 95 people in New Haven, Connecticut, overdosed. Their drug, however, wasn't heroin. It was synthetic cannabinoids, commonly sold as K2, Spice, or potpourri. The fallout from the incident was so widespread that experts have referred to it as a " mass casualty incident."

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https://www.recovery.org/pro/articles/3-dangerous-new-teen-drug-trends/

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Delaware Issues Warning on Heroin Products

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Delaware Issues Warning on Heroin Products

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Ohio State Highway Patrol Reports Heroin and Fentanyl Mixture in Ross Correctional Institution

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The Ohio State Highway Patrol identified a mixture of heroin and fentanyl found in the Ross Correctional Institution in Chillicothe after one inmate showed possible signs of an overdose and 27 staff members required medical attention on the morning of August 29, 2018. The inmate and several staff members received doses of naloxone prior to hospitalization. One staff member/first responder and one inmate remain in treatment.

For more information:

Connecticut Governor Warns of Overdoses Linked to K2/Spice

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The Governor of Connecticut, working with the state Department of Public Health (DPH) and Department of Mental Health and Addiction Services, issued a statement in response to a large number of overdoses linked to synthetic cannabinoids (K2 or Spice) in the New Haven, CT area in mid-August, 2018.

For more information about the alert:
https://portal.ct.gov/Office-of-the-Governor/Press-Room/Press-Releases/2018/08-2018/Gov-Malloy-Statement-on-Outbreak-of-Overdose-Cases-in-New-Haven and https://www.newhavenct.gov/news/displaynews.htm?NewsID=527&TargetID=61

For more information about synthetic cannabinoids:
https://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids-k2spice

FDA Warns of Synthetic Cannabinoids Laced with Anticoagulant

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The U.S. Food and Drug Administration issued a warning statement on July 19, 2018 about numerous health emergencies, mostly in midwestern states, caused by consumption of synthetic cannabinoid products laced with brodifacoum, an anticoagulant (blood-thinning) compound commonly used in rat poison. Hundreds of users of synthetic cannabinoid products typically sold in gas stations and convenience stores under various brand names such as "K2" and "Spice" have been treated for complications such as bleeding, and several people have died. Users of these products should be alert for bleeding and other symptoms like easy bruising, oozing gums, and nosebleeds and seek medical attention if they suspect they may have consumed contaminated drugs. Brodifacoum remains in the body a long time and can raise bleeding risk for weeks after consumption.

Delaware Health Officials Issue Warning on Heroin Products

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The Delaware Department of Health and Social Services issued a warning about heroin to people with substance use disorders, after two people died from suspected overdoses in a 24-hour period. The two deaths occurred on May 24 and May 25 and involved heroin packets with the same stamp. In Delaware, there have been 106 deaths from suspected overdoses through May 27 of this year, including three since Friday, May 25.

Physical signs of heroin overdose include:

Face is extremely pale or clammy to touch

Breathing is very slow or stopped

Body is limp

Fingernails or lips are blue or purple

Vomiting or making gurgling noises

Cannot be woken up from sleep or unable to speak

Slow heartbeat and/or low blood pressure

If you suspect an overdose, please call 911 immediately. Under Delaware's 911/Good Samaritan Law, people who call 911 to report an overdose and the person in medical distress cannot be arrested for low-level drug crimes.

For more information about the alert: https://news.delaware.gov/2018/05/29/delaware-health-officials-issue-warning-2-deaths-involve-stamp-packets-heroin/

For more information about heroin: https://www.drugabuse.gov/publications/drugfacts/heroin

New York City Police Department Issues Alert on Synthetic Cannabinoid Products

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Image Courtesy Lieutenant John Grimpel, NYPD

The New York City Police Department (NYPD) has issued an advisory alert for residents in the Brooklyn North Borough Command, warning people about a toxic batch of K2 that has been linked to 49 overdose cases since May 18. The NYPD is investigating the specific source of the drug distribution and has made arrests.

Synthetic cannabinoids like K2 are human-made mind-altering chemicals that are sprayed on dried, shredded plant material so they can be smoked or sold as liquids to be vaporized and inhaled in e-cigarettes and other devices. These products are also known as herbal or liquid incense and are marketed under a wide variety of specific brand names, including K2 and Spice and often labeled "not for human consumption."

Synthetic cannabinoids can cause serious mental and physical health problems including:

rapid heart rate

vomiting

violent behavior

suicidal thoughts

Officials urge citizens to call 9-1-1 immediately if they or someone they know are experiencing signs of overdose. For more information: http://nypdnews.com/2018/05/nypd-issues-k2-advisory-warning-brooklyn-residents/

Counterfeit "Oxys" Containing Dangerous Fentanyl in Mississippi

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Photo courtesy of NLMWhile not an actual photo of the recovered pills, this photo is very similar - round blue pills marked with "A 215."

Police in Gulfport Mississippi have issued a warning to the public (May 7, 2018) about counterfeit Oxycodone tablets that look like regular "oxys" but are actually made of the dangerous synthetic opioid fentanyl. Analysis in a DEA lab revealed the pills contained no oxycodone at all. Pills containing fentanyl carry a high risk of overdose and death, especially if users are unaware of their actual content and are likely to take too many. For more information: http://www.gulfportpolice.net/notices/public-notice-oxycodone-fentanyl/

FDA Cites 40 Retailers for Violations Related to Youth Sales of JUUL E-Cigarettes

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The Food and Drug Administration (FDA) has been conducting a nationwide effort to stop the sale of popular e-cigarette brands to youth, like JUUL, at brick-and-mortar stores and online retailers. Forty warning letters to various retailers were issued in April 2018. The JUUL brand is especially popular in youth and teens because it resembles a flash drive and is therefore difficult for parents and teachers to recognize. These products have high levels of nicotine and emissions that are hard to see. Reports show that teens are using and liking these products without knowing that they contain nicotine. This is problematic because we know that an adolescent brain is still developing, and early nicotine use can cause changes in the brain that result in continued use as an adult. Read more about the FDA press announcement.

FDA and FTC Take Action Against Manufacturers and Retailers Who Target E-Cigarettes to Youth

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Photo by: FDA

The National Poison Data System data between January 2012 and April 2017 indicates there were more than 8,000 e-cigarette and liquid nicotine exposures amongst children under six. Exposure to nicotine in children is especially dangerous and can result in serious harm or even death. The FDA has collaborated with the Federal Trade Commission (FTC) to warn companies about selling e-liquids used in e-cigarettes with advertising that resemble kid-friendly products.

Children are mistaking these products for juice boxes, cookies, or candy and consuming the products. The FDA is considering issuing product standards and other regulations on e-cigarettes and similar products, including limiting flavors that appeal to youth, implementing child-resistant packaging, and instituting strict product labeling. Read more about FDA and FTC's actions.

Multiple States Issue Alerts on Synthetic Cannabinoid Products

Updated

Update - Indiana and Wisconsin (April 6, 2018)

Indiana State Department of Health and Wisconsin Department of Health Services also issue a warning about the dangers of synthetic cannabinoid product use, reporting cases in their respective states in which synthetic cannabinoid product users experienced symptoms similar to those experienced in Illinois. Read more about the warnings from the Indiana State Department of Health and the Wisconsin Department of Health Services.

Update - Maryland (April 5, 2018)

The Maryland Department of Health and Maryland Poison Center issued a memorandum yesterday to Emergency departments, emergency medical services, health care facilities, and local health departments reporting on a case in central Maryland in which a user of synthetic cannabinoids was hospitalized with symptoms similar to those experienced by cases in Illinois linked to synthetic cannabinoid product containing a rat poison that acts as an anticoagulant. Read more about this memorandum from the Maryland Poison Center.

Additionally, the Illinois Department of Public of Health has issued a second warning on April 4, 2018, stating that they have now received reports of 81 cases. Read more about this updated alert from the Illinois Department of Health.

The Illinois Department of Public Health (IDPH) has reported 56 cases of users of synthetic cannabinoid products experiencing severe bleeding, likely due to contamination. In each case, hospitalization was required for coughing up blood, blood in the urine, severe bloody nose, or bleeding gums. Two people have died.

IDPH does not yet know which product or products are associated with the reported emergencies and deaths. Nine people tested positive for a lethal rat poison called brodifacoum that acts as an anticoagulant (causing bleeding), thus suggesting that the drugs had been laced with this substance. Synthetic cannabinoid chemicals, while potentially dangerous, are not known to cause bleeding. IDPH's investigation is ongoing.

Synthetic cannabinoids are chemicals related to THC (the active ingredient in marijuana), but often more potent, that are sprayed on dried, shredded plant material so they can be smoked or sold as liquids to be vaporized and inhaled in e-cigarettes and other devices. These products are also known as herbal or liquid incense and are marketed under a wide variety of specific brand names.

IDPH is advising that anyone who has a reaction to synthetic cannabinoid products, such as severe bleeding, should call 911 or have someone take them to the emergency department immediately. Read more about this alert from the Illinois Department of Health.

FDA Investigates Multistate Outbreak of Salmonella Infections Possibly Linked to Kratom Products

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The U.S. Food and Drug Administration (FDA) along with the Centers for Disease Control and Prevention (CDC) and state and local officials are investigating a multistate outbreak of Salmonella infections linked to products reportedly containing kratom. The CDC reports that 28 people ages 6 to 67 years in 20 states are infected, with 11 people who have been hospitalized. No deaths have been reported.

Salmonella bacteria cause the foodborne illness salmonellosis. Most people infected with Salmonella develop diarrhea, fever, and abdominal cramps. The illness usually lasts 4 to 7 days, and most people recover without treatment. However, in the current outbreak, an unusually high rate of cases have been hospitalized for their illness.

Kratom is a tropical deciduous tree native to Southeast Asia, with leaves that contain mitragynine, a psychoactive opioid. Kratom is consumed for mood-lifting effects, pain relief, and as an aphrodisiac. It is marketed in many forms, including leaves, pills, capsules, powder, and tea.

The FDA, CDC, and state and local officials are working to identify specific brand names or suppliers of products and will share more information as it becomes available. If you have questions about food safety, call 1-888-SAFEFOOD or consult the fda.gov website at http://www.fda.gov.

Iowa officials warn public about counterfeit oxycodone

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Health and safety agencies in Iowa have issued an advisory to warn Iowans of counterfeit pain pills containing dangerous synthetic opioids. The Iowa Division of Criminal Investigation's (DCI) laboratory analyzed pills made to resemble the prescription pain reliever oxycodone, finding them to contain more powerful and illicit synthetic opioids fentanyl and U-47700, putting users at higher risk of opioid overdose. Iowans with questions about synthetic opioids and emergency opioid reversal procedures can contact the Iowa Poison Control Center at 800-222-1222 or http://www.iowapoison.org.

More information is available from the I owa Department of Public Health, Department of Public Safety, Poison Control Center and Office of Drug Control policy.

In Georgia: Sudden surge in overdoses related to street drugs sold as yellow opioid pain medication

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UPDATE: The Georgia Bureau of Investigation (GBI) issued a press release on June 27, 2017, stating its crime labs have identified two new fentanyl analogues, acrylfentanyl and tetrahydrofuran fentanyl, warning that both can be absorbed through the skin and are considered highly dangerous. Neither is approved for human or animal use. The GBI states that multiple reports in other states indicate that the opioid reversal drug naloxone, may not be effective if someone overdoses after ingesting acrylfentanyl.

The Georgia Department of Public Health has issued an alert about a dangerous, potentially lethal substance contained in street drugs surfacing in central and South Georgia. Patients reportedly purchased yellow pills alleged to be Percocet, an opioid pain medication. The substance has not yet been identified but it is extremely potent and has required massive doses of naloxone (Narcan) to counteract its effects. Dozens of patients have been hospitalized and there are reports of deaths that may be associated with the drugs. The overdoses have been reported over a 48-hour period in Centerville, Perry, Macon-Warner Robins, and Albany, but the drugs may also be sold on the street in other areas of the state. Testing is being done to identify the pills and the ingredients.

Health officials urge citizens to call 9-1-1 immediately if you have taken the pills or if you think someone has used the drug. Read the warning from the Georgia Department of Public Health.

New York City issues Health Advisory about overdoses from fentanyl added to cocaine

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The New York City Health Department is warning citizens who use cocaine------even occasional users--- that the potent opioid fentanyl has been implicated in a growing number of cocaine-involved overdose deaths. In the past, fentanyl has been most commonly present in heroin-involved deaths, but fentanyl is increasingly being identified in overdose deaths involving other drugs. In 2016, 37 percent of overdose deaths involved cocaine and fentanyl without heroin, up from 11 percent in 2015.

Last year more than 1,300 New Yorkers died of a drug overdose, and nearly half (44 percent) of those deaths involved fentanyl In 2016. People who use cocaine occasionally and who are not used to taking opioids (i.e., have low tolerance) are considered to be at particularly high risk of overdose death. The NYPD Police laboratory testing data has confirmed the presence of fentanyl in with cocaine products as well as in counterfeit prescription sedatives (e.g., Xanax) and pain relievers purchased on the street, as well as in heroin, ketamine, and methamphetamine. Read the advisory from the New York City Health Department.

Gulf Coast HIDTA and the Georgia Bureau of Investigation Issue Synthetic Opioids Alert

Updated

Gulf Coast HIDTA Investigative Support Network "Grey Death" in rock form

There have been two new alerts issued related to synthetic opioids. The Gulf Coast High Intensity Drug Trafficking Area has issued an alert for a substance with the street name "Grey Death." The substance appears similar to concrete mixing powder and varies in texture, which ranges from a chunky rock-like material to a fine powder. It is not a single drug, but typically contains several potent opioids, including whatever a drug dealer has on hand in varying proportions. It has a potency much higher than heroin and is reportedly administered via injection, ingestion, insufflation, and smoking. The analysis of each grey death sample collected in the gulf coast region so far revealed the presence of three opioids: U-47700, heroin, and fentanyl; though the amount of each drug within grey death varied from sample to sample. (See Gulf Coast HIDTA Emerging Trend Bulletin: Potent new opioid/opiate compound known as "Grey Death" (PDF, 164KB))

In addition, the Georgia Bureau of Investigation (GBI) is issuing a public safety alert regarding illegal synthetic opioids that have caused more deaths in the first four months of the year than all of last year. In 2017, 17 deaths have been caused by the opioids U-47700 and/or furanyl fentanyl. U-47700 and furanyl fentanyl are both Schedule I drugs and used in the same manner as heroin. The drugs are distributed in either powder or tablet form. Furanyl fentanyl is a fentanyl analog and has been sold as a "designer" drug. (See Press release - GBI Issues Synthetic Opioids Alert)

DEA Temporarily Bans Synthetic Opioid U-47700 ("Pink"), Linked to Nearly 50 Deaths

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The U.S. Drug Enforcement Administration (DEA) has temporarily classified U-47700, nicknamed "Pink," a schedule I drug, which means it has a high potential for abuse and no approved medical use. Since last year, this dangerous synthetic opioid has been linked with at least 46 confirmed deaths-31 in New York and 10 in North Carolina. Law enforcement agencies have seized the drug in powder form and as counterfeit tablets that mimic pharmaceutical opioids. Earlier this year, law enforcement in Ohio seized 500 pills resembling a manufacturer's oxycodone immediate-release tablets. However, laboratory analysis confirmed that they contained Pink.

Pink belongs to a family of deadly synthetic opioids far more potent than morphine. It is usually imported to the United States, mainly from illicit labs in China. The drug can be toxic-even in small doses. It is typically taken by itself or combined with other drugs such as heroin and fentanyl.

Pink's name comes from the pinkish hue of the powder. It has been available for purchase over the internet and is misleadingly marketed as a "research chemical." Labels that state "not for human consumption" or "for research purposes only" are likely used in an effort to avoid legal restriction.

For more information, see the DEA news release on its scheduling of Pink.

DEA Issues Nationwide Warning on Carfentanil

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The Drug Enforcement Administration (DEA) has issued a nationwide warning to the public and law enforcement about human use of the potent animal opioid sedative carfentanil, one of the strongest opioids available. Carfentanil, a fentanyl analog with a potency approximately 10,000 times that of morphine, has been linked to a significant number of overdose deaths nationwide. It is used as a sedative or in general anesthesia for large animals, including elephants, but is not approved for use in humans. https://www.dea.gov/divisions/hq/2016/hq092216.shtml

In August 2016, NIDA posted carfentanil warnings by authorities in Ohio and Florida. As with many fentanyl analogs, it is likely that carfentanil is being added to mixtures of heroin and other street drugs, but it is not known how often carfentanil is being added to or substituted for other opioids in street drugs, underscoring its danger. More information can be seen under the August 23rd, 2016 posting below.

Fentanyl-Related Overdoses Prompt Alert from CDC

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The Centers for Disease Control and Prevention (CDC) has released an alert to public health departments, health care professionals, first responders, and others through its Health Alert Network about the increase in fentanyl-related overdoses and deaths in many parts of the country. Fentanyl is an extremely potent synthetic opioid-50 times stronger than heroin. Traditionally, fentanyl and analogs such as carfentanil have been mixed with powder heroin. Fentanyl-laced heroin has been linked to a surge of overdoses in Indiana and Ohio in late August, 2016. Fentanyl and related compounds are also being found in counterfeit pills made to look like prescription pain relievers and sedatives (e.g., OxyContin ®, Xanax ®, Norco ®). These counterfeit pills are also the subject of a recent Drug Enforcement Administration alert.

Those who use heroin or prescription drugs laced with fentanyl are at much higher risk of overdose and death. When emergency personnel are able to respond in time, they sometimes need multiple doses of naloxone to reverse fentanyl overdoses.

Alert Issued in Ohio for Human Use of Animal Sedative Carfentanil, with Cases Also Seen in Florida

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Officials in the Cincinnati area (Cuyahoga County) have issued an alert about human use of the potent animal opioid sedative carfentanil, one of the strongest opioids on the market, with a potency approximately 10,000 times that of morphine and 100 times that of fentanyl. Carfentanil is an analog of the synthetic opioid analgesic fentanyl and is used as a sedative or in general anesthesia for large animals, including elephants. Side effects of fentanyl analogs in humans are similar to those of fentanyl itself, which include itching, nausea, and potentially serious respiratory depression, which can be life-threatening. Officials in Ohio have noted a high number of overdoses in a short period of time that are suspected to be from carfentanil. NIDA's National Drug Early Warning System (NDEWS) reports several confirmed deaths in Akron and Columbus, and numerous seizures of the drug throughout Ohio. Read the public health warning from Cuyahoga County, Ohio.

In Florida (Manatee County), there was a recent seizure of carfentanil and a coincidental increase in overdoses and deaths. While more than a dozen fentanyl analogs are commonly flagged in postmortem testing in many states, it is difficult to assess how commonly carfentanil is being abused because states have few reference materials on this drug and few labs are equipped to test for it. The forensic toxicology laboratory researchers at the University of Florida are currently developing a new assay for the identification of carfentanil and will soon start including it in postmortem overdose death testing. Laboratory personnel are being warned about the potency of the drug and are advised to handle it with great care. Naloxone (Narcan®) should be available in the case of accidental exposure.

As with many fentanyl analogs, it is likely that carfentanil is being added to mixtures of heroin and other street drugs. Currently, it is unclear how often carfentanil is being added to or substituted for other opioids in street drugs, underscoring the risks of using illegal drugs.

More information can be found at the National Library of Medicine's Pubchem database - carfentanil.

Fake Prescription Drugs Laced with Fentanyl

Updated

The Drug Enforcement Administration reports that the United States is in the midst of a fentanyl crisis, as traffickers are flooding the drug market with counterfeit prescription drugs containing fentanyl, an extremely powerful opioid. These pills, which look like legitimate prescription pain relievers or sedatives, are causing large numbers of fatal overdoses in many parts of the country. Because of its high potency, fentanyl is deadly in very small doses; it is even hazardous for law enforcement, as a lethal dose can be accidentally inhaled or absorbed through skin contact. For more information, see the DEA report - Counterfeit Prescription Pills Containing Fentanyls: A Global Threat (PDF, 3.1MB).

Original Alert

Media reports and official alerts in several U.S. communities (including Sacramento, CA and most recently, Carroll County, MD) are warning of counterfeit pain and anxiety medications that actually contain fentanyl, an extremely powerful, potentially deadly opioid. The pills, which are disguised as common prescription drugs like Norco (hydrocodone), Percocet (oxycodone), and Xanax (alprazolam), are responsible for a growing number of overdose deaths and non-fatal overdoses around the country. Fentanyl is 25 to 50 times stronger than heroin, so even a small amount can cause an overdose. (The Drug Enforcement Administration reports that some of these pills are manufactured in China and smuggled into the U.S. via Mexican drug cartels.)

The fake pills are much cheaper than the real versions. The public should be aware that drugs obtained on the street, even though they look like a real prescription pharmaceutical, may be deadly. It is always unsafe to take a prescription drug unless it comes from your own prescription and is dispensed by a reputable pharmacy.

Synthetic Cannabinoid Advisory in New York City

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On July 14, 2016, New York City health officials issued an advisory about an increase in adverse events and emergency department visits related to synthetic cannabinoids (K2/Spice). From July 11 through July 13, 130 people were taken to emergency rooms after suspected ingestion of these drugs, which are sold under many street names including Geeked Up, Smacked, Scooby Snax, Green Giant, Red Giant, M. Bad Guy, Trippy, Ice Dragon, AK-47, and Kick. Synthetic cannabinoids, sometimes called "fake weed" or "herbal incense," are chemically related to THC, the active ingredient in marijuana, but they may be much more powerful. Their effects can be unpredictable and have caused death in some cases. In recent cases in New York City, some users' overdoses resemble opioid overdoses, including lethargy and suppression of breathing; in other cases they have exhibited agitated and violent behavior. The increase in emergency room admissions might indicate that the K2/Spice products circulating in the New York City area might be laced with other toxic chemicals. View Advisory (PDF, 61KB)

For more information on synthetic cannabinoids, see DrugFacts: K2/Spice ("Synthetic Marijuana")

Loperamide Misuse/Abuse

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Loperamide is an over-the-counter anti-diarrheal medication that is available in tablet, capsule, or liquid form under brand names such as Imodium, Kaopectate 1-D, Maalox Anti-Diarrheal, and Pepto Diarrhea Control. Because it acts at mu-opioid receptors, which regulate movement in the intestinal tract, it is an opioid medication, and there are reports of its being misused by drug users to stave off opioid withdrawal or possibly even to get high.

Misuse of loperamide has been reported since 2003; it is not common, but it has been reported all over the country. Nationwide, the number of calls to poison centers involving the intentional abuse or misuse of loperamide increased from 87 in 2010 to 190 in 2014 (AAPCC annual reports; http://www.aapcc.org/annual-reports/ ).

Effects of Loperamide

When taken as recommended, loperamide is designed not to enter the brain; but instructions available on the Internet purport to show how taking loperamide in very high quantities and combining it with other substances may help it produce psychoactive effects that resemble the euphoric effects of other opioids or that mitigate cravings and withdrawal symptoms.

Users' reports of these effects (if any) are conflicting, but physical consequences of loperamide misuse may be severe, including fainting, abdominal pain, constipation, cardiovascular toxicity (including racing heart and even cardiac arrest), pupil dilation, and kidney failure from urinary retention. Anecdotes and case reports indicated that the potential harm is high.

There were also reports of opioid withdrawal symptoms when users stopped taking loperamide, including severe anxiety, vomiting, and diarrhea.

FDA issued a Safety Alert about Loperamide on 6/7/16: Loperamide (Imodium): Drug Safety Communication - Serious Heart Problems With High Doses From Abuse and Misuse

More information on loperamide is also availabe from the National Drug Early Warning System (NDEWS).

Surge in Fentanyl Overdose Deaths

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A surge in overdose deaths related to fentanyl, an opioid 30 to 50 times more potent than heroin, has prompted Baltimore health officials to launch a public health campaign to raise awareness among drug users. Hundreds of people have overdosed on fentanyl across the nation since 2013, often as a result of using heroin that has been laced with the much stronger substance. A quarter of drug overdose deaths in Maryland now involve fentanyl, up from 4 percent in 2013. Opioid overdose can stop a person's respiration, and fentanyl can have this effect very quickly. Other parts of the country such as Detroit and surrounding suburbs are also seeing major surges in fentanyl use and fentanyl-related deaths. In some cases users are unknowingly taking fentanyl in what they believe to be pure heroin, but a growing number of opioid users are deliberately taking fentanyl.

Fentanyl and other opioid overdoses can be reversed if the drug naloxone (Narcan) is administered promptly. In a growing number of states, naloxone is being distributed to injection drug users and other laypersons to use in the event of overdose. For example, Baltimore's Staying Alive Drug Overdose Prevention and Response plan issues naloxone and training in its use.

Increasing Overdoses From Synthetic Cannabinoids ("Spice," "K2," etc.) in Several States

Updated

Recent surges in hospitalizations and calls to poison control centers linked to consumption of synthetic cannabinoid products--sold under brand names like "Spice," "K2," "No More Mr. Nice Guy," and others--are being reported in several southern and northeastern U.S. states and have prompted officials to issue health warnings. After a surge in synthetic cannabinoid exposures and poison center calls in April and May, 2015, the Maryland Poison Center issued an urgent notice about the dangers of these drugs. New York Governor Andrew Cuomo issued an alert after more than 160 patients were hospitalized following synthetic cannabinoid use in under two weeks in mid April, 2015.

Synthetic cannabinoids are chemically related to THC, the active ingredient in marijuana, and are sometimes called "synthetic marijuana" or "legal marijuana," but actually the effects can be considerably more powerful and more dangerous than marijuana. Users can experience anxiety and agitation, nausea and vomiting, high blood pressure, shaking and seizures, hallucinations and paranoia, and they may act violently.

The Maryland notice lists several chemical compounds in materials from crime labs, including MAB-/AB-CHMINACA, FUBINACA, FUB-PB-22, and XLR11. Besides the brand names above, the New York State health alert lists other common names: Blonde, Summit, Standard, Blaze, Red Dawn X, Citron, Green Giant, Smacked, Wicked X, AK-47; recent reports have involved products with the names Geeked Up, Ninja, Caution, Red Giant, and Keisha Kole.

For more information on synthetic cannabinoids, see DrugFacts: K2/Spice ("Synthetic Marijuana")

U.S. and British Columbia Issue Alerts on Fentanyl

Updated

The U.S. Drug Enforcement Agency (DEA) has issued a nationwide alert about the dangers of fentanyl and related compounds (fentanyl analogues). Fentanyl, an opioid that is 50-100 times more powerful than morphine, is both abused on its own and commonly added to heroin to increase its potency. Fentanyl and fentanyl-laced heroin have been a concern for over a decade and have caused numerous overdose deaths among injection drug users in several U.S. cities.

Heroin is not the only drug that can be laced with fentanyl, however. Officials in Vancouver, British Columbia, Canada, recently issued public warnings about a wide range of fentanyl-laced drugs causing overdose deaths among users. They warn that fentanyl is now being concealed in non-injection drugs, including oxycodone and various "party drugs" in powder or pill form, as well as in marijuana (although no deaths have been confirmed from fentanyl-laced marijuana). Because of this new threat, British Columbia officials are urging all recreational drug users to "know their source."

HIV Outbreak in Indiana Linked to Abuse of Opana

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Health officials in Indiana have announced a fast-spreading outbreak of new HIV cases in the southeastern portion of the state that are linked to injection drug abuse of the powerful prescription opioid painkiller Opana. Injecting drugs and sharing injection equipment is one of the main routes of transmitting HIV. Also, a few new HIV cases in southeastern Indiana were transmitted sexually.

Officials advise that people in southeastern Indiana who have engaged in needle sharing or unprotected sex should get tested for HIV and then re-tested after 2-3 months, as HIV may not appear on tests immediately when the virus is contracted. To reduce risk of contracting HIV, avoid injection drug use, sharing or re-using needles, and having unprotected sex or sex with commercial sex workers.

New Synthetic Cannabinoids-"Cloud 9," "Mojo," etc.

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Makers of designer drugs that are chemically similar to marijuana's active ingredient THC-called synthetic cannabinoids or colloquially "synthetic marijuana" or "synthetic pot"-are constantly creating new products to evade legal bans on older compounds. Despite the similarity on the molecular level, these drugs are much more dangerous than marijuana, and have resulted in very serious health consequences including overdoses and aggressive or suicidal behavior in users.

Some new compounds have recently emerged that are sending many users to the hospital in cities around the country. They include:

AB-PINACA, AB-FUBINACA (sold as "Cloud 9," "Relax," or "Crown") is sold as a liquid in eyedropper bottles and often used with vaporizing devices-e-cigarettes or "hookah pens." Numerous hospitalizations in Michigan prompted the Macomb County Health Department to issue an emergency warning and ban on the sale of these drugs, which are reported to cause hallucinations, aggressive behavior, racing heartbeat, drowsiness, and vomiting.

MAB-CHMINACA, ADB-CHMINACA (sold as "Mojo," "Spice," "K2," and "Scooby Snax") resulted in over 150 hospital visits in Baton Rouge and Lafayette, LA in October, prompting the governor to ban the drug in that state. It is reported to cause severe agitation, anxiety, and paranoia; raised heartbeat and blood pressure; nausea and vomiting; muscle spasms, seizures, and tremors; intense hallucinations and psychotic episodes, including suicidal fixations and other harmful thoughts.

Read more about "K2" and "Spice" synthetic cannabinnoids

This interview gives a personal perspective of Harvard Medical School's, Dr. Bertha Madras on the "Risks of Synthetic Designer Drugs."

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Posted on The Ohio State Highway Patrol identified a mixture of heroin and fentanyl found in the Ross Correctional Institution in Chillicothe after one inmate showed possible signs of an overdose and 27 staff members required medical attention on the morning of August 29, 2018.

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For a decade or more we've been hearing big government rhetoric on prevention of ill health, promotion of wellbeing, and "parity of esteem" for mental health. Speaking at last week's NHS Expo Conference, Public Health England's chief executive, Duncan Selbie, said that NHS England's 2014 Five Year Forward View had "told a fantastic story," yet its ambitions for prevention hadn't been implemented. 1 2 With the upcoming 10 year plan, 3 things had to change, he said.

In public health, prevention and treatment of alcohol misuse and its effects illustrate a huge mismatch between platitudes and practice.

The 2012 Health and Social Care Act shifted public health funding and provision to local authorities, ostensibly because local government has influence over wider societal determinants of health, such as education, housing, leisure, transport, and social care. 4 But local government budgets have been cut hard ever since, with public health hit hard. 5 6 In 2012-13 the ringfence on council budgets for drug and alcohol services was lifted.

In 2017 UK Addiction Treatment Centres published a report that was based on replies from 118 English local authorities to a freedom of information request. Their combined spending on services for drug and alcohol misuse from public health grants had fallen from £535m (€595m; $690m) in 2013-14 to £452m in 2016-17, a 16% cut. 7

In two of the report's examples, Manchester had reduced the proportion of its public health grant spent on drug and alcohol services from 30% to 16%, and Lancashire from 34% to 24%. Central government cut overall public health grants by more than £200m in 2016, so this is a smaller proportion of a smaller budget. In 2017 the Advisory Council on the Misuse of Drugs warned on the government's own website that sustained cuts to funding for drug and alcohol services were "short sighted and a catalyst for disaster." 8 It recommended that such services should be made mandatory within local government and brought more closely into local NHS commissioning.

The Institute of Alcohol Studies has shown, based on the retail price index and real terms income, that alcohol is now 60% more affordable than it was in 1980. 9 A 2017 systematic review by Boniface et al, including 33 studies and meeting all nine Bradford Hill criteria for establishing causality, concluded that price based policy interventions, including minimum unit alcohol pricing, were likely to reduce population alcohol consumption and related mortality and morbidity. 10 The Alcohol Health Alliance, comprising over 50 medical organisations and health charities, has called for these to become policy. 11

Other expert groups, such as the Institute for Fiscal Studies, have argued that tax changes could have a similar effect on price, while generating revenue for the exchequer that could be ploughed back into prevention and tackling health inequalities. 12

In Wales and Scotland minimum unit pricing is on the table or enacted. 13 The government's failure in England to act on price seems to disregard the weight of expert and empirical evidence. Such is the reality of having a tax funded, politically accountable NHS while public policy relating to wider determinants of health rests with other government departments, Treasury included. The drinks industry has a powerful and persistent lobby. 14 Pro-market think tanks such as the Adam Smith Institute repeatedly oppose pricing policies. 15

Why does any of this matter? Public Health England estimates a cost to the NHS of alcohol related harms of around £3.5bn a year and a social return of £3 for every £1 spent on alcohol services. 16 NHS Digital reported 337 000 hospital admissions related primarily to alcohol, 5507 alcohol specific deaths, and 80 000 people receiving treatment for alcohol misuse or dependence in 2017-18. This is a small fraction of the estimated 590 000 dependent drinkers in England. 17 Alcohol is the biggest risk factor for death, ill health, and disability in adults younger than 49 and the fifth biggest across all ages. 18

Dependent and hazardous drinking brings much wider harms to society, to individuals, and to families, hence Public Health England's estimated cost to society beyond the NHS of around £21.5bn a year. 16 Alcohol is heavily implicated in use of emergency services, attacks on their staff, and violent or motoring criminal offences, including those that lead to imprisonment. 18

NHS chief executive Simon Stevens said at the same NHS Expo Conference last week that we needed to "get serious about new public health threats." 19 I am sure he hasn't forgotten some of the older ones, such as alcohol. My concern is that however switched on our health service and public health leaders may be, the funding and the wider social policy to make their ambitions a reality rely on ministers, government communications teams, and Treasury officials. These parties are late to the party.

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David Oliver: Government's approach to alcohol harm is incoherent

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For a decade or more we've been hearing big government rhetoric on prevention of ill health, promotion of wellbeing, and "parity of esteem" for mental health. Speaking at last week's NHS Expo Conference, Public Health England's chief executive, Duncan Selbie, said that NHS England's 2014 Five Year Forward View had "told a fantastic story," yet its ambitions for prevention hadn't been implemented.12 With the upcoming 10 year plan,3 things had to change, he said.

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Bile Acid reduces Cocaine Reward

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Bile acids -- gut compounds that aid in the digestion of dietary fats -- reduce the desire for cocaine, according to a new study by researchers at Vanderbilt University Medical Center and the University of Alabama at Birmingham.

The findings, published in the journal PLOS Biology, suggest that targeting bile acid signaling in the brain may be a novel way to treat cocaine abuse.

Vanderbilt investigators Charles (Robb) Flynn, PhD, associate professor of Surgery, and Naji Abumrad, MD, John L. Sawyers Professor of Surgical Sciences, have long studied the metabolic changes associated with bariatric surgery for weight loss. Surgical patients experience dramatic changes in glucose regulation and in taste preferences and food cravings while they are still in the recovery room, Flynn said.

"These surgeries are doing something more than we understand. We wondered if elevated serum bile acids, a hallmark of bariatric surgery, were affecting the reward centers of the brain to blunt the pleasure of eating high-fat foods," he said.

If the surgery did affect the brain's reward centers, he added, "how might it impact the rewarding properties of drugs of abuse?"

The most commonly performed bariatric surgery -- Roux-en-Y gastric bypass -- restricts the size of the stomach and alters the path of food through the digestive tract. It also changes the point where bile acids enter the small intestine, from the usual upper part of the small intestine to a site near the end. The change increases circulating levels of bile acids in the body.

To explore the effects of bariatric surgery and elevated bile acids, Flynn's group developed a simpler surgical procedure in mice called bile diversion, in which the gall bladder is surgically connected to the end of the small intestine. Bile diversion in an obese mouse produces all of the beneficial effects of bariatric surgery: weight loss, reduced food intake and improved oral glucose tolerance, Flynn said.

With colleague Aurelio Galli, PhD, a former Vanderbilt faculty member who is now at the University of Alabama at Birmingham, the investigators found that bile diversion surgery in normal-weight mice reduced cocaine-induced increases in brain dopamine release and reduced cocaine-associated behaviors.

The researchers tested the effects of a synthetic bile acid drug called obeticholic acid (OCA), which is clinically approved to treat the chronic liver disease primary biliary cholangitis. In mice without surgery, OCA administration mimicked the effects of bile diversion surgery in reducing cocaine-associated behaviors. The investigators further demonstrated that the bile acid receptor TGR5 mediates the effects of elevated bile acids and OCA in the nucleus accumbens, a brain region that plays a central role in reward circuitry.

The study is the first to demonstrate a central nervous system role for bile acids in altering reward-related behaviors, and it opens the possibility of treating drug abuse in new ways.

"Will bile acids cure cocaine addiction in humans? We don't know, but our research certainly suggests that bariatric surgery or consumption of bile acids may have beneficial effects," Flynn said.

"OCA is already clinically approved, so it might be possible to move quickly to clinical trials of its efficacy in treating addiction."

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diet and weight loss; obesity; controlled substances; dietary supplements and minerals; cocaine; illegal drugs; addiction; dieting and weight control

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Investigators find that bile acids reduce cocaine reward

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Bile acids -- gut compounds that aid in the digestion of dietary fats -- reduce the desire for cocaine, according to a new study by researchers at Vanderbilt University Medical Center and the University of Alabama at Birmingham.

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Tuesday afternoon, the First State will become the first state to offer single-game sports wagering outside Nevada.

The expansion gives gamblers an alternative to those NFL parlay cards and will allow for various bets on professional baseball, football, hockey, basketball, soccer, golf, and more at the state's three casinos - Delaware Park, Dover Downs Hotel & Casino and Harrington Raceway & Casino.

CLOSE

The News Journal will be at Dover Downs and Delaware Park Tuesday, taking in the scene of what is a historical day for the state and for the country.

No longer is Las Vegas the home for sports wagering, and no longer are everyday or once-in-a-while sports bettors in Delaware and elsewhere only subject to the illegality of using a local "bookie" or betting online at an offshore sportsbook, like the popular Bovada online casino and sportsbook.

The times, they are changing. And betting at Delaware Park, Dover Downs and Harrington means no longer filling out a parlay card with three or more teams and turning your money over with about a 7/1 chance of actually getting anything back.

New Jersey is putting the final pieces to the puzzle together and will soon launch sports betting and become the epicenter of sports gambling on the east coast. Legislation isn't far behind in Pennsylvania, Illinois, New York and elsewhere.

But, for now, all eyes will be on Delaware Tuesday.

And speaking of those parlay cards? Forget about them.

Never placed a sports bet before? Need a little refresher? Want to know what Golden State -5 means for Game 3 of the NBA Finals Wednesday night or how to bet the Phillies on the road against the Cubs Tuesday night? We've got you covered.

Here's how you can sound like an expert when you get to the betting window Tuesday and get your first, legal straight bet in Delaware.

Important terms and phrases

Book: The sportsbook is an establishment that accepts wagering on sports. In Delaware, the three sportsbooks are Delaware Park, Dover Downs and Harrington Raceway.

Point spread: The point spread - or betting "line" as it is sometimes called - is the value assigned by the bookmaker that reflects an expected outcome of a game. For example, early indications are that Golden State is favored by 5 points (-5) against Cleveland in Game 3 of the NBA Finals Wednesday night. This means that Golden State is "giving up" five points to Cleveland and must win by 6 to cover the point spread. If you bet Cleveland +5, you win if the Cavaliers lose by less than 5 points or win the game outright. Typically, bets on the point spread are usually offered at 11-to-10 odds, meaning - for the sake of round numbers - a $110 bet will win the bettor $100.

Over/under: The over/under (sometimes written o/u) of a game is the total points expected to be scored. Like the point spread, over/under bets are usually offered at 11-to-10 odds.

Push: Quite simply, a tie. For example: if you have Golden State -5 Wednesday night, and the Warriors beat the Cavs by 5, the game is a push. Both Warriors and Cavaliers bettors get their wagers back.

Taking the points: When someone "takes the points," they're typically talking about betting the underdog (like Cleveland +5).

Underdog: The team most likely to lose, based on the betting odds. Many refer to this as the "dog."

Vigorish: There's always the vig. The vigorish is the commission or "juice" the casino takes. In our previous example, betting $110 on Golden State returns the bettor $210 instead of $220.

(Photo: Getty Images)

Types of bets

Straight bet: This is the hallmark of what makes Tuesday so historic. A straight bet is an individual wager on a game or event that will be determined by a point spread, money line or over/under.

Parlay: Like many Delawareans are probably familiar with, a parlay is a single bet that strings together two or more wagers and offers better payouts, but every leg of the parlay must hit for the bettor to win.

Money line bet: Bettors also have the option of betting on a team to win the game without the use of the point spread, meaning the margin of victory does not matter. This option means betting a favorite to win requires betting more money to get a desired return. For example, Golden State will be around -200 on the money line to win Game 3 Wednesday. Bettors would need to put down $200 to win $100. On the other end, betting an underdog to win usually comes with a good payout. The Cavaliers will be around +170 or more to win the game Wednesday. In that case, a bet of $100 wins the bettor $170.

Future: A future is a wager placed on an event such as which team will win next year's Super Bowl (the Eagles are 8/1 to repeat) or Master's golf tournament.

Teaser: Many Delawareans are already aware of a teaser, since the NFL parlay card system also allowed for teasers, a bet that adjusts point spreads in a player's favor but lessens the potential payout.
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We've covered above the typical ways to bet on an NBA game, but the Stanley Cup playoffs are nearing completion, and baseball season is in full swing. Here's how you bet on those sports.

Betting on hockey

Betting on hockey consists usually of money line bets, puck line bets (hockey's point spread) and over/under bets.

Monday night in Game 4 (Washington leads the series 2-1), the Washington Capitals are favored to beat Las Vegas. The Capitals are -130 on the money line and the Golden Knights are +110.

In most all hockey games, the puck line or point spread attached to the game is -1.5 goals. The odds of the favorite winning by more than one goal are then assigned to that line. For example, Washington is the 1.5 goal favorite Monday, but the odds of the Capitals covering the puck line is +215. So a $100 bet on the Capitals puck line Monday (they need to win by at least two) will win a bettor $215.

The over/under Monday night is 5.5 goals, a pretty standard value on most hockey games.

Betting on baseball

Betting on baseball is very similar to hockey. Each team is assigned a money line odd to win the game and baseball "run lines" (point spreads) are usually -1.5 for the favorite or +1.5 for the underdog, with odds assigned to those outcomes like explained above.
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The full-scale launch of betting in Delaware comes at a slow time in sports, especially for bettors. Come fall, when the NFL and college football seasons are underway and pro and college hoops are gearing up, Delaware's three sportsbooks should see plenty of traffic, especially if surrounding states continue to have holdups in launching.

Still confused? Want more information? The Delaware Lottery has a complete guide on its website.

Sports betting in Delaware gets a green light

Legalized sports betting will wreak havoc on college athletics. Or not.

Your state-by-state guide to sports betting in light of Supreme Court ruling
Contact reporter Jeff Neiburg at (302) 983-6772, jneiburg@delawareonline.com or on Twitter @Jeff_Neiburg.
Read or Share this story: https://www.delawareonline.com/story/money/business/2018/06/04/sports-betting-delaware-how/669113002/

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Single-game sports betting begins in Delaware

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Tuesday afternoon, the First State will become the first state to offer single-game sports wagering outside Nevada. The expansion gives gamblers an alternative to those NFL parlay cards and will allow for various bets on professional baseball, football, hockey, basketball, soccer, golf, and more at the state's three casinos - Delaware Park, Dover Downs Hotel & Casino and Harrington Raceway & Casino.

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http://ehealthmagz.com/2018/07/12/tramadol-the-most-dangerous-drug-in-the-world/

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https://www.usnews.com/news/politics/articles/2018-08-16/justice-dea-propose-reduction-in-prescription-opioid-manufacturing-quota