DR. DUPONT HIGHLIGHTS IMPORTANCE OF DRUG PREVENTION, TREATMENT
Reducing Future Rates of Adult Addiction Must Begin with Youth Prevention
The United States is confronting a public health crisis of rising adult drug addiction, most visibly documented by an unprecedented number of opioid overdose deaths.1 Most of these overdose deaths are not from the use of a single substance — opioids — but rather are underreported polysubstance deaths.2 This is happening in the context of a swelling national interest in legalizing marijuana use for recreational and/or medical use. As these two epic drug policy developments roil the nation, there is an opportunity to embrace a powerful initiative. Ninety percent of all adult substance use disorders trace back to origins in adolescence.3 4 New prevention efforts are needed that inform young people, the age group most at-risk for the onset of substance use problems, of the dangerous minefield of substance use that could have a profound negative impact on their future plans and dreams.
Moving Beyond a Substance-Specific Approach to Youth Prevention
The adolescent brain is uniquely vulnerable to developing substance use disorders because it is actively and rapidly developing until about age 25. This biological fact means that the earlier substance use is initiated the more likely an individual is to develop addiction. Preventing or delaying all adolescent substance use reduces the risk of developing later addiction.
Nationally representative data from the National Survey on Drug Use and Health shows that alcohol, tobacco and marijuana are by far the most widely used drugs among teens. This is no surprise because of the legal status of these entry level, or gateway, drugs for adults5 and because of their wide availability. Importantly, among American teens age 12 to 17, the use of any one of these three substances is highly correlated with the use of the other two and with the use of other illegal drugs.6 Similarly for youth, not using any one substance is highly correlated with not using the other two or other illegal drugs.
For example, as shown in Figure 1, teen marijuana users compared to their non-marijuana using peers, are approximately 8 times more likely to use alcohol, 12 times more likely to binge drink or drink heavily, 13 times more likely to smoke cigarettes and 9 times more likely to use other illicit drugs, including opioids. There are similar data for youth who use any alcohol or any cigarettes showing that youth who do not use those drugs are unlikely to use the other two drugs. Together, these data show how closely linked is the use by youth of all three of these commonly used drugs.
Figure 1. Past Month Prevalence of Alcohol, Cigarette and Other Illicit Drug Use among Youth Aged 12-17 by Past Month Marijuana Use
These findings show that prevention messaging targeting youth must address all of these three substances specifically. Most current prevention efforts are specific to individual substances or kinds and amounts of use of individual drugs (e.g., cigarette smoking, binge drinking, drunk driving, etc.), all of which have value, but miss a vital broader prevention message. What is needed, based on these new data showing the linkage of all drug use by youth, is a comprehensive drug prevention message: no use of any alcohol, tobacco, marijuana or other drugs for youth under age 21 for reasons of health.7 8 This no use prevention message provides clarity for young people, parents, physicians, educators, communities and for policymakers. It is not intended to replace public health prevention messages on specific substances, but enhances them with a clear focus on youth.
Some claim adolescent use of alcohol, cigarettes and marijuana is inevitable, a goal of no use of any drug as unrealistic and that the appropriate goal of youth prevention is to prevent the progression of experimentation to later heavy use or problem-generating use. These opinions are misleading and reflect a poor understanding of neurodevelopment that underpins drug use. Teens are driven to seek new and exciting behaviors which can include substance use if the culture makes them available and promotes them. This need not be the case. New data in Figure 2 show over the last four decades, the percentage of American high school seniors who do not use any alcohol, cigarettes, marijuana or other drugs has increased steadily. Fifty-one percent of high school seniors have not used any alcohol, cigarettes, marijuana or other drugs in the past month and 26% have not used any alcohol, cigarettes, marijuana or other drugs in their lifetimes. Clearly making the choice of no use of any substances is indeed possible — and growing.
Figure 2. Past Month Trends among High School Seniors in Abstaining from Alcohol, Cigarettes, Marijuana and Other Illicit Drugs
Sowing the Seeds for a New and Enduring Parents’ Movement
Key lessons for the future of youth prevention can be learned from the past. Substance use peaked among high school seniors in 1978 when 72% used alcohol, 37% used cigarettes, and 37% used marijuana in the past month.9 These figures have since dropped significantly (see Figure 3). In 2016, 33% of high school seniors used alcohol, 10% used cigarettes and 22% used marijuana in the past month. This impressive public health achievement is largely unrecognized.
Figure 3. Percentage of U.S. High School Seniors Reporting Past Month Substance Use, 1975-2016
Although the use of all substances has declined over the last four decades, their use has not fallen uniformly. The prevalence of alcohol use, illicit drug use and marijuana use took similar trajectories, declining from 1978 to 1992. During this time a grassroots effort known as the Parents’ Movement changed the nation’s thinking about youth marijuana use10 with the result that youth drug use declined a remarkable 63%. Rates of adolescent alcohol use have continued to decline dramatically as have rates of adolescent cigarette use. Campaigns and corresponding policies focused on reducing alcohol use by teens seem to have made an impact on adolescent drinking behavior. The impressive decline in youth tobacco use has largely been influenced by the Tobacco Master Settlement Agreement which provided funding to anti-smoking advocacy groups and the highly-respected Truth media campaign. The good news from these long-term trends is that alcohol and tobacco use by adolescents now are at historic lows.
It is regrettable but understandable that youth marijuana use, as well as use of the other drugs, has risen since 1991 and now has plateaued. The divergence of marijuana trends from those for alcohol and cigarettes began around the time of the collapse of the Parents’ Movement and the birth of a massive, increasingly well-funded marijuana industry promoting marijuana use. Shifting national attitudes to favor legalizing marijuana sale and use for adults both for medical and for recreational use now are at their highest level11 and contribute to the use by adolescents. Although overall the national rate of marijuana use for Americans age 12 and older has declined since the late seventies, a greater segment of marijuana users are heavy users (see Figure 4). Notably, from 1992 to 2014, the number of daily or near-daily marijuana uses increased 772%.12 This trend is particularly ominous considering the breathtaking increase in the potency of today’s marijuana compared to the product consumed in earlier decades.13 14 15 These two factors — higher potency products and more daily use — plus the greater social tolerance of marijuana use make the current marijuana scene far more threatening than was the case four decades ago.
Figure 4. Millions of Americans Reporting Marijuana Use, by Number of Days of Use Reported in the Past Month
Through the Parents’ Movement, the nation united in its opposition to adolescent marijuana use, driving down the use of all youth drug use. Now is the time for a new movement backed by all concerned citizens to call for no use of any alcohol, tobacco, marijuana or other drugs for youth under age 21 for reasons of health. This campaign would not be a second iteration of the earlier “Just Say No” campaign. This new no-use message focuses on all of the big three drugs together, not singly and only in certain circumstances such as driving.
We are at a bitterly contentious time in US drug policy, with front page headlines and back page articles about the impact of the rising death rate from opioids, the human impact of these deaths and the addiction itself.16 At the same time there are frequent heated debates about legalizing adult marijuana and other drug use. Opposing youth substance use as a separate issue is supported by new scientific evidence about the vulnerability of the adolescent brain and is noncontroversial. Even the Drug Policy Alliance, a leading pro-marijuana legalization organization, states “the safest path for teens is to avoid drugs, including alcohol, cigarettes, and prescription drugs outside of a doctor’s recommendations.”17
This rare commonality of opinion in an otherwise perfect storm of disagreement provides an opportunity to protect adolescent health and thereby reduce future adult addiction. Young people who do not use substances in their teens are much less likely to use them or other drugs in later decades. The nation is searching for policies to reduce the burden of addiction on our nation’s families, communities and health systems, as well as how to save lives from opioid and other drug overdoses.18 Now is precisely the time to unite in developing strong, clear public health prevention efforts based on the steady, sound message of no use of any alcohol, tobacco, marijuana or other drugs for youth under age 21 for reasons of health.
Robert L. DuPont, M.D.
President, Institute for Behavior and Health, Inc.
Former Director, National Institute on Drug Abuse (1973-1978)
Former White House Drug Chief (1973-1977)
We published another article by Dr. DuPont on addiction and Drug Policy Reform. For more than 40 years, Robert L. DuPont, MD has been a leader in drug abuse prevention and treatment. Among his many contributions to the field is his leadership as the first Director of the NIH National Institute on Drug Abuse (1973-1978) and as the second White House Drug Chief (1973-1977). Dr. DuPont has written for publication over 400 professional articles and 15 books and monographs on a variety of health-related subjects. His books include Getting Tough on Gateway Drugs: A Guide for the Family, A Bridge to Recovery: An Introduction to Twelve-Step Programs and The Selfish Brain: Learning from Addiction. A graduate of Emory University, Dr. DuPont received an MD degree in 1963 from the Harvard Medical School.
For complete article PARENTS OPPOSED TO POT
Footnotes:
1 Hedegaard, M., Warner, M., & Minino, A. M. (2017, December). Overdose deaths in the United States, 1999-2016. NCHS Data Brief, 294. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Available: https://www.cdc.gov/nchs/data/databriefs/db294.pdf
2Florida Drug-Related Outcomes Surveillance and Tracking System (FROST), University of Florida College of Medicine. http://frost.med.ufl.edu/frost/
3The National Center on Addiction and Substance Abuse at Columbia University. (2011). Adolescent Substance Use: America’s #1 Public Health Problem. New York, NY: Author. Available: https://www.centeronaddiction.org/addiction-research/reports/adolescent-substance-use-america%E2%80%99s-1-public-health-problem
4Among Americans age 12 and older who meet criteria for substance use disorders specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).
5Marijuana remains illegal under federal law but is legal in some states for recreational use the legal age is 21, and in some states for medical use, the legal age is 18. Nationally the legal age for tobacco products is 18 and for alcohol it is 21.
6DuPont, R. L. (2017, October 23). For a healthy brain teens make “One Choice”. Rockville, MD: Institute for Behavior and Health, Inc. Available: https://www.preventteendruguse.org/s/IBH_Commentary_One_Choice_10-23-17.pdf
7DuPont, R. L. (2015). It’s time to re-think prevention: increasing percentages of adolescents understand they should not use any addicting substances. Rockville, MD: Institute for Behavior and Health, Inc.
8Chadi, N., & Levy, S. (2017). Understanding the highs and lows of adolescent marijuana use. Pediatrics, 140(6). Available: http://pediatrics.aappublications.org/content/pediatrics/early/2017/11/02/peds.2017-3164.full.pdf
9Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2017). Monitoring the Future national survey results on drug use, 1975—2016: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan. Available at http://monitoringthefuture.org/pubs.html#monographs
10Dufton, E. (2017). Grass Roots: The Rise and Fall of Marijuana. New York, NY: Basic Books.
11Geiger, A. (2018, January 5). About six-in-ten Americans support marijuana legalization. Washington, DC: Pew Research Center. Available: http://www.pewresearch.org/fact-tank/2018/01/05/americans-support-marijuana-legalization/
12Caulkins, J. (2017, November 7). Psychoactive drugs in light of libertarian principles. Law and Liberty. Available: http://www.libertylawsite.org/liberty-forum/psychoactive-drugs-in-light-of-libertarian-principles/
13ElSohly, M. A., Mehmedic, Z., Foster, S., Gon, C., Chandra, S., & Church, J. C. (2016). Changes in cannabis potency over the last 2 decades (1995-2014): Analysis of current data in the United States. Biological Psychiatry, 79(7), 613-619.
14World Health Organization. (2016). The Health and Social Effects of Nonmedical Cannabis Use. Geneva, Switzerland: Author. Available: http://www.who.int/substance_abuse/publications/cannabis/en/
15Rocky Mountain High Intensity Drug Trafficking Area. (2017, October). The Legalization of Marijuana in Colorado: The Impact, Volume 5. Denver, CO: Author. Available: https://rmhidta.org/files/D2DF/2017%20Legalization%20of%20Marijuana%20in%20Colorado%20The%20Impact2.pdf
16E.g., Seelve, K. Q. (2018, January 21). One son. Four overdoses. Six hours. A family’s anguish. New York Times, p.A1. Available: https://www.nytimes.com/2018/01/21/us/opioid-addiction-treatment-families.html
17Drug Policy Alliance. (2018). Real drug education. New York, NY: Author. Available: http://www.drugpolicy.org/issues/real-drug-education
18The President’s Commission on Combatting Drug Addiction and the Opioid Crisis. (2017). Final Draft Report. Available: https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-15-2017.pdf
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buprenorphine published—17% respond
concludes, “Long-acting buprenorphine depot formulations appear to be efficacious for treatment of opioid use disorder.”
Keep reading.
They compared the effectiveness of sublingual (oral) and long-acting injections of buprenorphine to see if the long-acting injections are as effective as the sublingual version.
The study was 24 weeks. That’s better than we usually see.
They used two measures to compare them:
- Average percent of opioid-negative urine samples for 24 weeks.
- Percent of subjects with negative urine screens for illicit opioid use for at least 8 of 10 drug screens at prespecified points during weeks 9 to 24. (This was the criteria for being classified as responding to the treatment.)
Measure 1
- Sublingual buprenorphine — 28.4% (1099 of 3870) of urine screens were negative for opioids.
- Long-acting injectable buprenorphine — 35.1% (1347 of 3834) of urine screens were negative for opioids.
This means that 71.6% and 64.9% of the drug screens were positive for opioids. It’s also worth noting that they do not report whether they also screened for any other drugs.
Measure 2
- Sublingual buprenorphine — 14.4% (31 of 215) of these subjects were negative for opioids in 8 out of 10 urine screens at prespecified points during weeks 9 to 24.
- Long-acting injectable buprenorphine — 17.4% (37 of 213) of these subjects were negative for opioids in 8 out of 10 urine screens at prespecified points during weeks 9 to 24.
So, this measure doesn’t tell us much about what happened during weeks 1 to 8, but we know that 85.6% and 82.6% of subjects screened positive for opioids at least 3 times during the 10 testing points over weeks 9 to 24.
Recovery?
Do we know anything about the number of subject who achieved recovery during this 6 month study?
Not really.
What we know
- There was a lot of opioid use by subjects.
- 15.8% of all subjects screened negative for opioids >80% of the time at those 10 testing points.
What we don’t know
- Did any subjects successfully abstained from opioids?
- Despite the high rates of opioid use, did some subjects migrate toward something resembling stable recovery?
- What were the rates of alcohol and other drug use?
- What kind of quality of life improvements were made over the course of the 6 months?
- What was the retention rate? (There’s no mention of dropout. If dropout was not an issue, how did they achieve that?)
- How would these subjects have done if they were offered the gold standard treatment?
- What other services/supports subjects received.*
Press releases about this study refer to it as effective, positive and promising. Keep in mind, when people say maintenance medications are the most effective treatments, this is what they are talking about.
It’s not that these medications can’t be or shouldn’t be part of the treatment system. In fact, I believe that they ought to be available to every single person who wants them. At the same time, when some patients, families, providers, and other systems are reluctant to embrace these outcomes, there may be reasons other than stigma or ignorance.*
For complete article https://addictionandrecoverynews.wordpress.com/2018/06/10/study-of-long-acting-buprenorphine-published-17-respond/
![\"\"](\"http://www.dontlegalizedrugs.com/wp-content/uploads/2018/06/ConferenceLOGO1.png\" "\\"ConferenceLOGO\\"")
6th World Forum Against Drugs, the 25th ECAD MAYORS\’ CONFERENCE Without your participation the Conference wouldn’t have reached its goal of sharing best experiences, knowledge and new research amongst different actors within the field. Together we work for a drug free world! You can find presentations and statements at the conference website: http://www.wfadecad2018.se/ and access the conference photos here. If you would like to continue receiving information from WFAD you can sign up to our newsletter by becoming a member, or by following us on Facebook and Instagram. To register yourself or your organization as a member of WFAD, apply here: http://wfad.se/membership. If you would like to continue receiving information from ECAD you can sign up to our newsletter here or access our website at www.ecad.net. To subscribe to Judge Peggy Hora’s (Justice Speakers Institute) newsletter on Drug Treatment Courts and/or other justice issues, go to JusticeSpeakersInternational.com where you can sign up for the newsletter on the right side of the page. The organizing committee sees how valuable cooperation between cities and civil society is and look forward to continued collaboration! Best wishes, The organizing committee
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One in six cases of psychosis are linked to cannabis use, claims psychiatric expert
- Professor Robin Murray said that smoking cannabis is linked to psychosis
- He said 50,000 people have the condition due to smoking cannabis as teenagers
- His comments follow a renewed debate over the legalisation of the drug PUBLISHED: 25 June 2018
A psychiatric expert has claimed one in six people with psychosis in Britain would never have developed it if they had not smoked cannabis.
Professor Robin Murray, an authority on schizophrenia at King’s College London, said about 50,000 people were now diagnosed as psychotic solely because they used the drug while teenagers.
Many had no family history of psychosis and would have had no risk of developing the disease if they had not smoked high-strength cannabis, he claimed.
Professor Robin Murray said one in six people with psychosis in Britain would never have developed it if they had not smoked cannabis. Stock picture
The academic’s comments follow a renewed debate over the legalisation of the drug, following the first ever NHS prescription for cannabis oil being given to 12-year-old Billy Caldwell to treat his epilepsy last week.
The Royal College of Psychiatrists has also spoken out to warn that cannabis use doubles the risk of someone becoming psychotic, after former Tory leader William Hague suggested it should be decriminalised for recreational use.
Professor Murray said: ‘If you smoke heavy, high-potency cannabis, your risk of psychosis increases about five times.
‘A quarter of cases of psychosis we see in south London would not have happened without use of high-potency cannabis. It is more prevalent in that area, but the figure for Britain would be one in six — or approximately 50,000 people.’
For complete story http://www.dailymail.co.uk/sciencetech/article-5881123/Psychiatric-expert-claims-one-six-people-psychosis-linked-cannabis-use.html
Britain’s biggest festival organiser dismays campaigners by backtracking on support for drug testing
\’Considering the huge profits made by companies like Festival Republic from ticket sales, they should be funding essential services like The Loop to protect festival goers from avoidable harm\’
- Mattha Busby @matthabusby Sunday 3 June 2018 12:11
There have been several drug-induced deaths at events run by Festival Republic in recent years ( )
The UK’s largest festival organiser has reversed its previous support for drug testing facilities in a U-turn that drew criticism from experts and campaigners.
Festival Republic — which organises Reading and Leeds Festivals, among others — said testing “has the ability to mislead” and cast doubt on the growing body of evidence which suggests testing festival goers\’ drugs for potency and impurity, as well as providing individualised advice, reduces drug-related harm.
“Determining to a punter that a drug is in the ‘normal boundaries of what a drug should be’ takes no account of how many he or she will take, whether the person will mix it with other drugs or alcohol and nor does it give you any indicator of the receptiveness of a person’s body to that drug.”
- Bestival to offer drug testing for first time in bid to prevent deaths
- Woman’s death at Bestival was ‘tragic accident not murder’
Such a licence is unlikely to materialise since the government’s current position is that “no illegal drug can be assumed to be safe and there is no safe way to take them”.
Steve Moore, the director of VolteFace, a drugs policy think tank, said that “festival organisers can no longer shun responsibility by hiding behind the ‘zero tolerance’ mantra” after last weekend’s tragic deaths, given “what we know about that the dangers of the current illicit drug market”.
“As businesses that legitimately profit from facilitating hedonism on a vast scale they have to be at the forefront of investment in harm reduction and lobbying public authorities for the legal clearances to do so,” he said.
The Home Office said earlier this week: “Drugs can devastate lives, ruin families and damage communities. This government’s approach remains clear that we must prevent drug use in our communities and support people through treatment and recovery.
“No illegal drug can be assumed to be safe and there is no safe way to take them.
“Our drug strategy brings together police, health, community and global partners to tackle the illicit drug trade, protect the most vulnerable and help those with a drug dependency to recover and turn their lives around.”
In comments on his change of stance on drug testing, Mr Benn told The Independent: \”Yes, this has been a change but it’s a minor change. However, the change developed after much discussion with medical professionals, police forces and licensing authorities.\”
\”There are no safe illegal drugs.\”
For complete article https://www.independent.co.uk/news/uk/home-news/music-industry-giant-festival-republic-backtrack-support-drug-testing-a8379296.html (cited 20/6/18)
BIG MARIJUANA MOVES TO EXPLOIT THE OPIOID EPIDEMIC
Bottom of FormRemarks prepared by Drug Free America Foundation, March 2018. Get a downloadable copy here.
July 2018
Marijuana use is associated with an increased risk of prescription opioid use. The National Institute on Drug Abuse analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions and found respondents who reported past-year marijuana use in their initial interview had 2.2 times higher odds than nonusers for having a prescription opioid use disorder and 2.6 times greater odds of abusing prescription opioids.[i]
Marijuana use seems to strengthen the relationship between pain and depression and anxiety, not ease it. A recent study that surveyed 150 adults receiving MAT examined whether marijuana use diminishes the relationships between pain, depression, and anxiety and whether self-efficacy influences these interactions. The study concluded that marijuana use strengthens the connection between feelings of pain and emotional distress. Marijuana use was also associated with a low sense of self-efficacy, making it harder for them to manage their symptoms.[ii]
The current opioid epidemic in the US has been universally recognized as one of the most important public health issues to date. Opioid overdoses have increased by 200% since 2000 with more than 53,000 individuals dying from an opioid overdose in 2016 alone. Opioids have dominated drug policy and funding discussions at both the state and federal level and now Big Marijuana is moving in to profit from this health care crisis.
Leveraging an ecological study,[iii] the marijuana lobby is pushing states to expand medical marijuana access to include opioid use disorders. The evidence that increased access to marijuana has reduced opioid overdose deaths however is weak and shortsighted. The cited study fails to account for a decade worth of drug prevention and policy efforts that reduced access to powerful prescription opioids as well advancement of overdose prevention strategies.
For complete article http://www.poppot.org/2018/06/29/big-marijuana-exploits-opioid-epidemic/
Marijuana addiction is real: Forget about \’gateway drug\’ fears – 4 million Americans are hooked on cannabis itself and there is NO treatment
- Marijuana is now legal in 31 states, either for medical or recreational purposes
- Growers are making strains as much as 10-times stronger than they were 40 years ago
- Though it can be used safely, many are under the misconception that marijuana is non-addictive
- The National Institutes of Health estimate that four million Americans are addicted to marijuana
For complete article http://www.dailymail.co.uk/health/article-5883793/Marijuana-addiction-real-Forget-gateway-drug-fears-4-million-Americans-hooked-weed.html (June 2018)
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