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To Stop the Opioid Epidemic, the White House Should Embrace Prevention

Fri, 11/03/2017 - 07:50
If you never start using opioids, you're not going to get strung out on them.

There’s an old adage that states “An ounce of prevention is worth a pound of cure.”

President Donald Trump declared a public health emergency on opioid use on Oct. 24. He outlined several strategies to address the crisis, including plans to establish drug courts in every federal judicial district; to adjust reimbursement rates for addiction treatment; and to streamline federal funding for drug treatment programs.

These plans focus primarily on treating opioid addiction after the problem is detected. In our response to the opioid crisis, the “pound of cure” is prominent. But where can we find the ounce of prevention?

Any comprehensive response to a health issue must consider those who have not developed the problem. When public health and medical professionals responded to the H1N1 crisis several years ago, for example, a great deal of time and resources were devoted to teaching people how to avoid contracting this potentially life-threatening disease.

People are dying from the opioid overdose epidemic, and we must mount an aggressive response in order to save lives. But let’s not forget the needs of those who haven’t developed opioid addiction, or those who are at risk for addiction. Their life trajectories could be changed with the support of timely and responsive prevention efforts.

Why prevention matters

What does prevention entail? At a basic level, prevention means stopping a behavior, like opioid abuse, from ever occurring in the first place. To experts in public health and related professions, it can also entail delaying the onset of that problem behavior or reducing its impact.

Most importantly, prevention also means strengthening individual and community-level health and resilience, as well as promoting policies that improve physical, social and emotional well-being.

Research clearly shows that prevention is effective at enhancing human functioning and reducing psychological and physical distressPrevention services help to further the health and well-being of both individuals and entire communities across many areas – for example, reducing the negative consequences of alcohol abuse, sexually transmitted infections, diabetes and many other conditions.

There’s clear evidence that expanding preventive services reduces the costs of substance abuse and mental health care. Prevention allows health care workers to address problems early, before costly treatment is necessary.

Prevention policies have been effective in reducing death rates. For example, states that raised the legal drinking age to 21 saw a 16 percent median decline in motor vehicle crashes.

Prevention services can also mitigate the consequences of health issues that may disproportionately affect demographic groups by race, gender, disability, socioeconomic class and other factors.

The importance of prevention is affirmed by the U.S. National Prevention Strategy, a government initiative that aims to shift our nation’s focus from sickness and disease to wellness and prevention.

Preventing opioid abuse

With regard to prevention strategies for opioid abuse and addiction, the federal government has laid out some potentially promising strategies. However, the current opioid emergency response places most of the federal focus – and, likely, available funding – on the needs of a relatively small segment of the population: those with existing opioid use disorders and addiction.

A much larger segment of the population is affected in other ways. Many may have a family member or friend experiencing such addiction. Or they may themselves be at risk of starting to abuse opioids. These people need help to ensure that opioid use problems do not develop in the first place.

There are a few ways that the government can ensure that its current plan addresses the need for prevention.

The White House commission addressing the opioid abuse issue recommended a system for distributing federal funding. This system mirrors the process for obtaining block grants, allocations to states to support substance abuse services. While this recommendation is encouraging, we should ensure that some of these funds are designated to address the needs and build the strengths of individuals and communities who have not yet been affected by the opioid crisis.

The commission also plans to coordinate with private sector and nonprofit groups to implement a national media campaign. This campaign will address addiction stigma and the danger of opioids. As part of this recommendation, it would be important to include messaging indicating that most members of the population do not use opioids, as well as specific steps that communities can take to remain healthy and drug-free.

Finally, the government says it will implement policies that ensure patients are adequately educated about the risks, benefits and alternatives of taking opioids before receiving an opioid prescription for chronic pain. Just as important is the provision promoting the use of nonpharmacological alternatives for pain management by health care professionals.

A comprehensive approach

A comprehensive public health-informed approach to address the opioid crisis may involve responses that affect an entire population, offer early intervention for people who may be at risk for opioid abuse and provide treatment and referral for individuals with already established opioid addiction.

Mapping a comprehensive approach to the opioid crisis. M. Dolores Cimini and Estela M. Rivero, CC BY

As a psychologist who works in alcohol and drug abuse prevention, I believe that public health professionals need to better understand what makes some individuals gravitate to opioid abuse and addiction. Such findings can help to develop strategies to promote health and resilience.

What’s more, we need to expand federal funding to support research across the spectrum of substance use. Substance abuse in all its forms compromises the health and welfare of millions across our nation. President Trump’s heartfelt comments about his brother, Fred, who died as a result of his addiction to alcohol, underscored this point.

One individual and community at a time, we must focus on supporting the millions of people who haven’t developed opioid addiction. That way, we can stem the tide associated with this devastating public health crisis.


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White House Opioid Commission Blows Teachable Moment

Thu, 11/02/2017 - 14:17
Click here for reuse options! The "just say no" approach is not only ineffective, it's harmful to preventing drug abuse.

The White House Commission on the opioid crisis released its final report on November 1st. The report contained a range of recommendations including increasing the number of drug courts and launching a public campaign to prevent abuse of opioids and to challenge the stigma associated with its use.  

While much of the focus on the Commission’s final report is understandably on critiquing its recommendations, there is a larger issue at play—what is absent from the report altogether. The Commission blew an opportunity to share with the public what is well-known and understood by public health and addiction experts on the frontlines of the opioid epidemic—that there are proven harm reduction and treatment interventions that will be far more effective at curbing overdose fatalities than any supply reduction or enforcement strategy.

By adopting an integrated approach to prevention, education, harm reduction, including ensuring widespread distribution of naloxone, and evidence-based treatment it is possible to dramatically reduce the number of deaths related to opioid use.

Prevention programs should focus on empowering and educating people, especially young people who are dying preventable deaths, about opioids. While understanding the root causes of problematic drug use is complicated, educating and empowering those who use or may be considering using opioids is a move away from the hopelessness that appears to be driving opioid use in young people.

What we do know is that campaigns based on orders to “just say no” fail in part because they do not engage young people or provide realistic and safe options for people who may choose to use despite potentially negative consequences.

Harm reduction strategies and programs have a strong track record of improving the health of people using opioids and preventing overdose deaths.  There are a wide range of well-established harm reduction practices.  Some are as simple of teaching young people how to stay safe when partying. Other proven measures are setting up safe consumption sites, enacting Good Samaritan laws that encourage people to seek help when someone is in distress without fear of punishment and ensuring that people in the best position to reverse an overdose—people who use drugs themselves or their friends and families—have easy access to the overdose antidote medication naloxone.

Another life-saving harm reduction technique is to give people who use opioids a means of testing the substance they are using to see if it has been adulterated with fentanyl or some other substance that could lead to an overdose or other adverse reaction.

Harm reduction programs enable people with expertise in drug use to engage with those who are using problematically, earn their trust, and potentially guide them toward voluntary treatment programs. Judgment and the threat of being punished for drug use drives people who use drugs underground and into greater danger of an overdose or other adverse reaction. Harm reduction, on the other hand, saves lives.  And yet, the term “harm reduction” is not even mentioned throughout the Commission’s 100+ page report.

There were, however, some glimmers of hope in the Commission’s recommendations, such as calling for increased access to evidence-based addiction treatment with medications such as methadone and buprenorphine. But, there are serious reservations about how President Trump’s analysis will influence the implementation of even the best recommendations and legitimate concerns that ramping up a failed war on drugs will lead to more preventable deaths.

Punitive responses to opioid drug use, including the promotion of drug courts which are integrated into the criminal justice system, not only fail to protect the lives of people who use drugs, but by portraying opioids and fentanyl as “bad” drugs, people seeking palliative care are also made to suffer. Opioids, including fentanyl, can be used to great effect therapeutically. Opioids can also lead to deadly overdoses. Doubling down on a punitive approach to drug use will impact both people’s access to pain medicines as well as their willingness to voluntarily seek help and treatment for any problematic drug use. Creating drug policies that are grounded in public health principles and informed by compassion, not judgment, means that the government can implement measures that save lives and reduce suffering.

This piece originally appeared on the Drug Policy Alliance blog.


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The Feds Think Pot Is a Greater Threat Than Opioids

Thu, 11/02/2017 - 10:31
Click here for reuse options! Prosecutorial priorities appear skewed.

By now, anyone who is awake is aware that the country is experiencing a lethal opioid crisis. Opioid overdose deaths are at record highs, President Trump has declared a national public health emergency, and Congress is considering an ever-growing number of bills aimed at addressing the crisis.

Someone needs to tell the DEA and the Justice Department. While their public policy pronouncements identify opioids as a key concern, a look at who is actually being prosecuted for federal drug offenses shows that heroin and prescription opioid cases account for only a small fraction of all federal drug cases.

Most tellingly, at a time when more than 60 million Americans enjoy legal marijuana in their home states and when opinion polls show strong and increasing majorities in favor of legalization nationwide, drug agents and federal prosecutors are still devoting more resources to marijuana than to heroin.

And it's not just marijuana. The feds also pursued more cases against methamphetamine offenders and cocaine offenders than they did against heroin dealers, even though the number of heroin and prescription opioid users far outnumbers either the meth or the cocaine using populations and even though meth and cocaine are far less implicated in the overdose crisis than heroin and prescription opioids.

Rhetoric is one thing; what actually happens on the ground is another. And as these 2016 statistics from United States Sentencing Commission demonstrate, heroin and prescription opioids have not been a high priority for either the DEA agents who bring cases or the US Attorneys' offices that prosecute them.  

According to the data, only 14.2% of federal drug prosecutions went after heroin. That's a 29% increase over 2012, but still only a small percentage of all drug cases. An additional 2.8% of cases involved oxycodone, but that figure has been declining for the past several years and is largely a remnant of pill mill prosecutions from early in this decade. Many of the oxycodone cases came from the Eastern District of Kentucky, one of the epicenters of the pill mill phenomenon.

Marijuana cases, on the other hand, made up 17.6% of all federal drug prosecutions last year—more than the heroin and oxycodone cases combined. And remember, this was last year, when the Obama administration was in power. While it's too early for 2017 statistics, it's probably safe to assume that a Justice Department led by marijuana foe Jeff Sessions is not going to oversee a decrease in pot cases.

But what the feds really have their eyes on is meth and cocaine. Meth accounted for a full third (33.6%) of all federal drug prosecutions, while powder and crack cocaine cases accounted for another 27.9%. The numbers don't lie: Federal drug enforcement efforts emphasize meth and coke, and then marijuana, over heroin and prescription opioids.

Anti-prohibitionists will argue that there should be no drug prosecutions; that drug prohibition only exacerbates the problems related to drug use, and that's a fair point. But we live in a prohibition regime, and the priorities of DEA agents and US attorneys in that regime are fair game. That the feds make marijuana a higher prosecutorial priority than heroin is just absurd. 

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If You Can't Afford $4,500 for a Dose of Medicine, You Don't Get to Live

Thu, 11/02/2017 - 08:51
"We face a choice—watch as price-gouging constricts access to naloxone or do something about it."

The war on opioids is in full force, and we are losing. More than 64,000 Americans will die overdose deaths this year. Tighter regulations on prescription narcotics may just be shifting those with opioid addictions back to heroin cartels. During his last term, President Obama signed a bill funding $1 billion into programs combating opioid addiction, including programs that increased access to naloxone, the antidote for opioid overdoses. The current administration announced this year its plan to grant $485 million from the Department of Health and Human Services (HHS) to states to fight opioid addiction. At the same time, synthetic opioids like carfentanil are proving highly resistant to common doses of naloxone, sometimes requiring 10 or more doses of naloxone to reverse an overdose.

The opioid crisis quickly became a state of emergency. More than 40 states responded by making naloxone available without a prescription for the express purpose of enabling family members to revive their loved ones in case of overdose. Other local initiatives have involved the push to make naloxone available to all first responders, including the police and even their K9s who may be exposed to lethal levels of opioids at crime scenes.

While these initial strides have helped to combat deaths from opioid overdose, the financial burden is becoming exhausting. Naloxone has been on the market since 1971 and became generic in 1985. The drug itself is cheap, with current wholesale price cited as $0.33 for a 2ml vial or $11.70 for 10 2ml vials by the International Medical Product Guide. Comparatively, in the US, a simple vial of naloxone is 40 times that price. Price-gauging poster child Mylan of the now infamous EpiPen scandal sells naloxone at $23.72/ml, Hospira sells it at $14.25/ml, Amphastar at $19.8/ml and West-Ward at $20.40/ml.

These prices are for the drug naloxone only, and do not include any of the delivery devices like auto-injectors or nasal injectors. As a result, they are only helpful to medically-trained persons like paramedics, often funded by state and local taxpayer dollars. Citing cost concerns, communities have begun to propose "one and done" or "three strikes" rules where people are limited on the number of overdose responses they get from city ambulance services -- so the next time they call, the city will just let them die. Middletown, Ohio, was one of those cities -- a town that is on track to spend over $2 million this year responding to opioid addiction problems, with $100,000 on Narcan alone.

With government capabilities already limited by cost, the burden of life-saving shifts to private (usually lay, non-medically trained) consumers of naloxone, almost always family members of an opiate user. These loved ones need a naloxone option that is easy to deliver in a crisis, without the training required for syringes and measurements needed to use simple vials of naloxone. This is where the price gouging becomes more appalling. For a drug that costs as low as $0.16/ml, current naloxone options for the lay consumer are exorbitantly cost prohibitive. The naloxone auto-injector by Kaleo Pharma costs $4,500, and the naloxone nasal spray by Adapt Pharma, a simple plastic nasal sprayer that could be manufactured for pennies, now costs $110. This is the price to save a life now, with a generic drug that has been on the market for nearly 50 years.

This is concerning, especially for people living in poverty who are disproportionately affected by addiction. Concerned by the public health ramifications of this, earlier this year,  31 US senators sent a letter to Kaleo, maker of Evzio, demanding an explanation for not only the cost of the drug, but also the 600 percent price hike in the drug. Like Mylan during the EpiPen scandal, Kaleo responded by citing donations of its product to various agencies, as well as a complicated web of rebates and discounts. These do make the drug more affordable for some patients, usually those with insurance, but more often than not, this results in increased market share as consumers are swayed to use the product and not enough impact from a population health perspective. Already, Kaleo has maxed its donations of product, but many that received those devices now rely on it. Meanwhile, Kaleo is enjoying a 20 percent overall market share on the retail naloxone dispensed. For the 40-64-year-olds that most often need naloxone, Kaleo holds an even more solid 50 percent of the market share.

Pharmaceutical price gouging has created a situation where access to life-saving medicines is limited by profit margins. As government agencies are already struggling with costs, the burden gets shifted to the private consumer. In that market, the message is clear: If you can't afford $4,500 for a dose of medicine, you don't get to live. In a way, haven't these pharmaceutical companies now become the "death panels" in the "rationing of health care" that we once so feared during the initial Affordable Care Act debates?

Naloxone is a life-saving drug, one that serves the public in an increasingly important way as we continue to search for other ways to limit the devastation caused by the ongoing opioid crisis.

As one example, Harm Reduction Therapeutics is a nonprofit pharmaceutical company that is working to maximize naloxone's over-the-counter availability while minimizing the price and financial burdens to consumers, first responders, and state and local governments. Co-founder and CEO Michael Hufford noted that "philanthropic foundations backing this new nonprofit pharmaceutical model will help with an urgently needed response to the opioid crisis, while realizing a tremendous return on their investment, measured not in dollars, but in lives saved."

With such public impact, it is time to stop relying on "pharma bros" and start creating and incentivizing nonprofit or government and academic-sponsored institutions for an alternative.  Store shelves need to be flooded with easy-to-use naloxone devices that are sold for what they cost to make and distribute. Only then will the supply of this life-saving generic drug begin to meet the tragic demand for it.

In the words of Hufford, "As lives are lost every day from opioid overdoses, and debate continues as to whether it formally constitutes a crisis, we face a choice -- watch as price-gouging constricts access to naloxone or do something about it. We have chosen to do something about it."

Correction: This article incorrectly stated the amount of funding for fighting opioid addiction provided by legislation signed by President Obama. The 21st Century Cures Act, a bill signed into law by Obama last year, provides $1 billion in opioid funding. 

Copyright, Truthout. Reprinted with permission. 

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Could Cigarettes and Booze Be the Real "Gateway Drugs"?

Thu, 11/02/2017 - 08:37
Using these legal substances preps the brain for cocaine addiction, new research suggests.



Alcohol reshapes the brain in ways that make rats more likely to become cocaine addicts

The idea of a "gateway drug" may sound like a throwback to the "Just say no" era. But new research offers fresh evidence that alcohol and nicotine — two psychoactive agents that are legal, ubiquitous and widely used during adolescence — ease the path that leads from casual cocaine use to outright addiction.

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Marijuana Legalization And Crime: The Only Facts You Need To Know

Thu, 11/02/2017 - 08:25
Researcher: Cannabis legislation 'is not predictive of higher crime rates.'

It’s been one of the primary claims made by the opponents of cannabis regulation for generations: Increased marijuana use will lead to more violent crime. Here are the facts about marijuana legalization and crime.

Earlier this year, Attorney General revived the debate when he declared:

“We’re seeing real violence around that (marijuana legalization). Experts are telling me there’s more violence around marijuana than one would think and there’s big money involved.”

The nation’s top cop didn’t provide any data or clarify where he received his information. (“Experts are telling me ..” is clearly not verifiable.)

But data provided by official state agencies simply does not support the claims of the attorney general. States that regulate and license the production and distribution of cannabis have not seen “more violence around marijuana.” Nor have they seen an increase in violent crime. Statistics demonstrate that many jurisdictions have experienced a drop in violent crime following legalization efforts.

An important caveat: Advocates on both sides of the issue will toss around numbers in an attempt to support their argument. But correlation does not necessarily imply causation. One thing is certain: The fear-mongering of increased crime surrounding marijuana regulation is a canard.

A 2014 study published by researchers at the University of Texas demonstrated that the enactment of “medical marijuana laws precedes a reduction in homicide and assault. … In sum, these findings run counter to arguments suggesting the legalization of marijuana for medical purposes poses a danger to public health in terms of exposure to violent crime and property crimes.”

Robert Morris from the University of Texas, analyzed data supplied from the FBI and found:

“[Medical marijuana legislation] is not predictive of higher crime rates and may be related to reductions in rates of homicide and assault. … Given the relationship between alcohol and violent crime, it may turn out that substituting marijuana for alcohol leads to minor reductions in violent crimes.”

Another study published by researchers at UCLA reported that the growth of medical marijuana outlets in urban areas “was not associated with violent crime or property crime rates.” The researchers suggested that medical marijuana dispensaries may reduce neighborhood crime because of the security precautions taken by business owners.

In the state of Washington, which legalized adult recreational consumption three years ago,  violent crime fell 10 percent statewide.

In Seattle, the state’s largest city, overall crime numbers in February 2017 were the lowest in five years. So far this year, there has been a major drop in crime rates.

Rates of violent crime and property crime fell in the city of Denver following legalization. Crime rates have similarly declined in Portland, Oregon according to a recent CATO think-tank policy report.

According to CATO’s researchers:

“The absence of significant adverse consequences is especially striking given the sometimes dire predictions made by legalization opponents.”

No credible data exists that supports an association between increased violent crime and regulated cannabis.  Studies suggest that violent crime goes down in states with legalized medical marijuana.

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Trump Opioid Panel Will Recommend Nationwide Drug Courts, Tightened Prescribing Rules

Wed, 11/01/2017 - 08:17
The draft proposal is definitely a mixed bag.



Trump opioid panel will recommend nationwide drug courts, tightened requirements for prescribers

WASHINGTON - President Trump's commission on combating the opioid epidemic plans to encourage the federal government to establish drug courts in every federal judicial district, adjust reimbursement ...

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Here Is Why Congress Believes Marijuana Is the Same as Heroin and Meth

Wed, 11/01/2017 - 08:06
This ridiculous idea is the fault of the Controlled Substances Act, but why is Congress trying to dupe the public?

Earlier this week, Congressman Tom Garrett, a Republican freshman from Virginia, introduced legislation aimed at federally decriminalizing marijuana. The bill — “Ending Federal Marijuana Prohibition Act of 2017” — would take marijuana off the federal controlled substances list,  joining other industries such as alcohol and tobacco instead of heroin and meth.

“I have long believed justice that isn’t blind, isn’t justice. Statistics indicate that minor narcotics crimes disproportionately hurt areas of lower socio-economic status and what I find most troubling is that we continue to keep laws on the books that we do not enforce,” Garrett said in a statement.

Hawaii Congresswoman Tulsi Gabbard is the lead co-sponsor on this bipartisan bill.

The proposed legislation is identical to the bill introduced in 2015 by Sen. Bernie Sanders, which failed to even get a hearing.

Before we get into why Garrett proposed the legislation, it’s worth reviewing the basics of the Controlled Substances Act of 1970 and why marijuana is classified as a Schedule I drug — the highest tier that includes heroin. According to the federal government, Schedule I drugs have a “high potential for abuse” and “no medically accepted use.”

Here is what you need to know about the CSA and the scheduling of marijuana:

How Did This Happen?

It all started in 1970. Congress passed the Controlled Substance Act, which was immediately signed by President Richard Nixon, who felt strongly that marijuana use was tearing the fabric of the nation. He associated marijuana users with hippies and anti-war protesters. The act established five schedules — or categories — by which all drugs would be classified.

The inclusion of cannabis as Schedule I was supposed to be temporary, subject to review by a commission that would recommend a categorization based on science.

Two years later, the blue-ribbon commission’s recommendation was in. The National Commission on Marihuana and Drug Abuse issued two substantial reports: Marihuana: A Signal In Misunderstanding and Drug Use in America: Problem in Perspective.

The commission concluded that marijuana was not a serious threat to public health and recommended changes to the scheduling. In fact, the so-called Shafer Commission — named after the Raymond Shafer, the chairman of the panel and former Pennsylvania governor — recommended that small amounts of cannabis should be legal to possess. The report stated:

“The criminal law is too harsh a tool to apply to personal possession even in the effort to discourage use.  It implies an overwhelming indictment of the behavior which we believe is not appropriate. The actual and potential harm of use of the drug is not great enough to justify intrusion by the criminal law into private behavior, a step which our society takes only with the greatest reluctance. … Therefore, the Commission recommends … [that the] possession of marijuana for personal use no longer be an offense.”

Nixon, who hand-picked all 13 members of the Shafer Commission, ignored its recommendation.

Side note: Cocaine and methamphetamine, opium and other clearly more dangerous drugs fall under Schedule II.

What About Medical Marijuana?

Yes, what about the medicinal use of an herb that the federal government states no medically accepted use.” Twenty-eight states disagree and have passed legislation that allows for the medical marijuana programs.

Even more head-scratching is this: In 2003, the U.S. Department of Health and Human Services received U.S. Patent No. 6,630,507. The patent clearly states that the compounds found in cannabis act as antioxidants and neuroprotectants. The patent summary states:

Cannabinoids have been found to have antioxidant properties, unrelated to NMDA receptor antagonism. This new found property makes cannabinoids useful in the treatment and prophylaxis of wide variety of oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases. The cannabinoids are found to have particular application as neuroprotectants, for example in limiting neurological damage following ischemic insults, such as stroke and trauma, or in the treatment of neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease and HIV dementia.

Since all states are not required to keep data on patients using medical marijuana, it is unclear how many Americans are using the plant for health reasons. One national estimate claims the number to be 2.6 million. According to a recent study by the Pew Research Center estimates:

Nearly half (49 percent) of Americans say they have tried marijuana, and 12 percent in the past year, which the 2012 National Survey on Drug Use and Health says is the most commonly used illicit drug in the U.S. The government survey showed that 18.9 million Americans 12 or older (7.3 percent) had used marijuana in the prior month.

The Pew report does not differentiate between medical use and other use.

What About CBD?

Cannabidiol, or CBD, is a non-psychoactive substance found in the cannabis plant. It has no effect on brain function and is proven to be an antioxidant and neuroprotectant. Are CBD-only medications legal? Nope. Inexplicably, even cannabis devoid of THC, the psychoactive ingredient in marijuana, is considered by the federal government to be Schedule I.

The DEA announced in December that cannabis extracts, including CBD, fall under Schedule I.

So, What About Rescheduling?

It is unlikely that the federal government will do anything soon to change the status of cannabis, despite the fact that more Americans live in states that approve of medical marijuana than states that don’t.

Rescheduling could be achieved via Congress, or through the executive branch. Congress thus far has rejected all bills to reschedule. There is also a provision in the CSA that allows the attorney general the latitude to reschedule administratively.

As mentioned at the top of this article, Congressman Garrett has introduced legislation. But that is seen by most political experts as a symbolic gesture. Just last year, the DEA rejected a call to reschedule.

The first attempt to reschedule occurred in 1972, the same year the act went into effect. NORML petitioned the federal government to move cannabis to Schedule II.

There have been numerous other attempts over the years and all have been unsuccessful.

Note: The 2016 platform of the Democratic Party called for removal of marijuana from Schedule I, “providing a reasoned pathway for future legalization” of marijuana.

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Cannabis and Sleep Disturbances: What You Need to Know

Tue, 10/31/2017 - 08:16
Is your marijuana use helping or hindering your ability to get a good night's rest? Highlights: 
  • Sleep disturbances are the most common health problem in America. Those with sleep issues are poorly served by prescription and over-the-counter sleeping pills and other pharmaceuticals, which have serious risks.

  • CBD and other plant cannabinoids show promise for treating insomnia, sleep apnea, narcolepsy, and other sleep-related disorders.

  • CBD co-administered with THC improves sleep more efficaciously than single-molecule medications.
  • Chronic, heavy consumption of THC-dominant cannabis can disrupt healthy sleep patterns.
  • Our ability to be awake, fall asleep, stay asleep and wake up feeling rested is part of an internal biological process regulated by circadian rhythms and the endocannabinoid system.
Shut-eye overview

Although sleep is essential for our health, its biological purpose is not fully understood. Oddly, the seemingly inactive state of sleep is actually a dynamic and critical process that helps us store memories, build immunity, repair tissue, regulate metabolism and blood pressure, control appetite and blood sugar, and process learning, along with a myriad of other physiological processes – all of which are regulated by the endocannabinoid system (ECS).

According to the National Institute of Neurological Disorders and Stroke at the National Institute of Health (NIH), new findings suggest “sleep plays a housekeeping role that removes toxins in your brain that build up while you are awake.”

Poor sleep is the number one reported medical complaint in the Unites States and a serious public health concern. The average adult needs between seven and eight hours of sleep per day. Yet, 10-30 million Americans regularly don’t get enough sleep.

Over 60 percent of American adults report having problems sleeping several nights per week.

Over 40 million Americans suffer from more than 70 different sleep disorders. The most common sleep-related ailments include:

  • Insomnia - when one cannot fall asleep or stay asleep.
  • Sleep apnea - which involves impaired breathing while sleeping.
  • Restless leg syndrome - characterized by tingling, discomfort and even pain in the legs that increases at night and is relieved by movement.
  • Circadian rhythm disorders - when one’s internal clock is off and one’s sleep patterns are disturbed.
  • Parasomnias - which entails abnormal movements and activities while sleeping, including sleep walking and nightmares.
  • Excessive daytime sleepiness - when an individual experiences persistent drowsiness during daylight hours from narcolepsy or another medical condition.

Poor sleep is a risk factor for serious illness. Compared to people who get enough sleep, adults who are short-sleepers (less than 7 hours per 24-hour period) are more likely to experience one or more of 10 chronic health conditions, including obesity, heart disease, diabetes, arthritis, stroke and depression.

Those with chronic illnesses are at greater risk for insomnia, which exacerbates their discomfort. Comorbid medical disorders – including conditions that cause hypoxemia (abnormally low blood oxygen levels) and dyspnea (difficult or labored breathing), gastroesophageal reflux disease, pain, and neurodegenerative diseases – have a 75-95 percent increased risk of insomnia.

Pills that kill

In 2016, according to the industry research firm MarketsandMarkets, Americans spent $3.38 billion on prescription sedatives and hypnotics, over-the-counter (OTC) sleep drugs, and herbal sleep aids. It’s projected that the market for such products will experience about a 4.5 percent growth rate between now and 2021.

The quest for good night’s sleep can be hazardous to one’s health. Daniel F. Kripke, MD, sleep expert and co-founder of Research at Scripps Clinic Vitebri Family Sleep Center, discusses the dangers of sleep aids in his paper “Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit.”

Dr. Kripke reviewed 40 studies conducted on prescription sleeping pills, which include hypnotic drugs such as zolpidem (Ambien, Edlmar, Intermezzo and Zolpimist), temazepam (Restoril), eszopiclone (Lunesta), zaleplon (Sonata), triazolam (Halcion), flurazepam (Dalmane and Dalmadorm), quazepam, and other barbiturates used for sleep. Of these 40 studies, thirty-nine found that consumption of hypnotics is “associated with excess mortality” to the tune of a 4.6 times greater risk of death for hypnotic users.

Grim statistics: 10,000 deaths per year are directly caused by and attributed to hypnotic drugs, based on medical examiner data. However, large epidemiological studies suggest the number of fatalities may actually be closer to 300,000-500,000 per year. The difference can be attributed to underreported use of hypnotics at the time of death and the fact that prescription hypnotics are rarely listed as the cause of death.

Dr. Kripke concludes that even limited use of sleeping pills causes “next day functional impairment,” increases risk of “on-the-road driver-at-fault crashes,” increases falls and accidental injuries especially among seniors, is associated with “2.1 times” as many new depression incidents compared to randomized placebo recipients, and increases the risk of suicide. Furthermore, the use of opioids combined with hypnotics – two known dose-dependent respiratory suppressants – can be extremely dangerous, especially when mixed with alcohol and other drugs.1

Alarming data

Another concern: Data from controlled hypnotics trials resulted in 12 cancers in hypnotic participants compared to zero cancers in the placebo group. (When the FDA conducted the same audit, they found 13 cancers.) But it is unclear if the hypnotics were a causative factor in these cancers or if they were promoting progression of cancer that had previously gone undetected. Animal and in vitro (test tube/petri dish) studies also attest to the pro-cancer potential of hypnotics. To learn more visit Dr. Kripke’s website.

In addition to these risks, meta-data (combined data) from placebo-controlled randomized clinical trials showed participants in the hypnotic groups had a 44 percent higher infection rate than the placebo participants.

Are over-the-counter sleep aids any better? These also have adverse side effects. Most OTC sleeping pills (Benadryl and others) have the antihistamine diphenhydramine as the primary ingredient. It can knock you out, but it’s unlikely to provide truly restful sleep.

In an email exchange with Project CBD, Dr. Kripke writes: “Usage of diphenhydramine is associated with developing Alzheimer’s disease, though which is cause and which is effect is certainly unclear. One well-known aspect of diphenhydramine is that it is anticholinergic [blocks the neurotransmitter acetylcholine], that produces some heart symptoms sometimes as well as digestive symptoms such as constipation. In some patients, also, diphenhydramine at night causes rather a lot of daytime sleepiness.”

A large number of OTC sleep aids also include acetaminophen, a pain reliever that has a narrow therapeutic window – meaning at one dose it’s therapeutic, but the slightest increase can be toxic to the liver. All too often consumers don’t read the warning labels about these drugs and consume them with alcohol and other meds. This can cause liver toxicity and/or fatal respiratory suppression.

OTC sleep aids are intended only for occasional or short-term use – never more than two weeks at one time. Although it is not typically reported in the published literature, those who use OTC and prescription sleep aids find that once they start it’s hard to stop.

The endocannabinoid system and sleep

Given the problems with conventional soporifics, medical scientists have been exploring other ways to improve sleep by targeting the endocannabinoid system (ECS). As the primary homeostatic regulator of human physiology, the ECS plays a major role in the sleep-wake cycle and other circadian processes.

Italian scientist Vicenzo DiMarzo summarized the broad regulatory function of the endocannabinoid system in the phrase “Eat, sleep, relax, protect and forget.”

How we fall asleep, stay asleep, wake up, and remain awake is part of an internal biological process regulated by our circadian rhythms and our endocannabinoid system. Circadian rhythms govern a diverse array of actions in the body, including hormone production, heart rate, metabolism, and when to go to sleep and wake up.

It’s as if we have an internal biochemical timer or clock that keeps track of our need for sleep, guides the body to sleep and then influences the intensity of sleep. This biological mechanism is affected by external forces such as travel, medication, food, drink, environment, stress and more.

Key question: Does the endocannabinoid system regulate our experience of circadian rhythms or vice versa?

Evidence of a strong relationship between the two is observed in the sleep-wake cycle fluctuations of anandamide and 2-AG (the brain’s own marijuana-like molecules), along with the metabolic enzymes that create and break down these endogenous cannabinoid compounds.

Anandamide is present in the brain at higher levels at night and it works with the endogenous neurotransmitters oleamide and adenosine to generate sleep. Conversely, 2AG is higher during the day, suggesting that it is involved in promoting wakefulness.

The highly complex sleep-wake cycle is driven by a variety of neurochemicals and molecular pathways.2 Both anandamide and 2AG activate CB1cannabinoid receptors that are concentrated in the central nervous system, including parts of the brain associated with regulating sleep.

CB1 receptors modulate neurotransmitter release in a manner that dials back excessive neuronal activity, thereby reducing anxiety, pain, and inflammation. CB1 receptor expression is thus a key factor in modulating sleep homeostasis.

This is not the case, however, with respect to the CB2, the cannabinoid receptor located primarily in immune cells, the peripheral nervous system, and metabolic tissue. Whereas CB1 receptor expression reflects cyclical circadian rhythms, no such fluctuations have been described for the CB2 receptor.

The challenge of studying and treating sleep disturbances is complicated by the fact that sleep disorders are symptomatic of many chronic illnesses. In many cases, poor sleep results in chronic illness, and chronic illness always involves an underlying imbalance or dysregulation of the endocannabinoid system. Although we still have much to learn about the relationship between the ECS and circadian rhythms, it’s clear that adequate quality sleep is a critical component of restoring and maintaining one’s health.

Cannabis for slumber

Cannabinoids have been used for centuries to promote sleepiness and to help people stay asleep. In the acclaimed medical reference Materia Medica, published in the 18th century, cannabis was listed as a ‘narcotica’ and ‘anodyna’ (pain reliever). Its reintroduction to Western medicine by Sir William B. O’Shaughnessy in 1843 led to studies that underscored the remedial properties of “Indian hemp” for sleep disorders.

“Of all anaesthetics ever proposed, Indian hemp is the one which produced a narcotism most closely resembling the natural sleep without causing any extraordinary excitement of the vessels, or any particular suspension of secretions, or without fear of a dangerous reaction, and consecutive paralysis,” German researcher Bernard Fronmueller observed in 1860.

Nine years later Fronmueller reported that in 1000 patients with sleep disturbance, Indian hemp produced cures in 53 percent, partial cure in 21.5 percent, and little or no effects in 25.5 percent.

Sleep-related problems continue to drive a large percentage of people to seek relief with cannabis.

Poor sleep and lack of sleep cause physiological changes in the body after just one night, resulting in slower reaction times, deceased cognitive performance, less energy, aggravated pain and inflammation, and in many cases overeating or cravings for high-fat, high-carbohydrate “comfort” foods.

A 2014 study by Babson et al notes that approximately 50 percent of long-term cannabis consumers (over 10 years) report using cannabis as a sleep aid. Among medical marijuana patients, 48 percent report using cannabis to help with insomnia.

Another study revealed that 40 percent of insomniacs also suffer from anxiety and depression or another a psychiatric disorder. (Roth, 2007) Would it surprise you to learn that people with mood disorders who use cannabis have the highest rates of sleep benefit at 93 percent? (Babson & Bonn-Miller, 2014)

“Sorrow can be alleviated by good sleep.” So said Thomas Aquinas.  CBD, THC, CBN

What about specific plant cannabinoids for sleep?

Cannabidiol (CBD) is alerting or mildly stimulating in moderate doses, while its psychoactive counterpart delta 9-tetrahydrocannabinol (THC) tends to be sedating. However, the science is somewhat paradoxical.

Research data and anecdotal accounts indicate that CBD and THC have differential effects on sleep – both can be alerting or sedating depending on dosage.

The biphasic dose response triggered by CBD and THC is one of the factors that may contribute to conflicting research results with respect to cannabinoids and sleep.3

The association between low-dose cannabidiol and increased wakefulness underscores CBD’s potential as a treatment for narcolepsy and other variants of excessive daytime sleepiness.

Curiously, CBD can help people fall asleep as well as stay awake. An insomnia study indicated that the administration of 160 mgs of CBD decreased nighttime sleep interruptions and increased total sleep time, suggesting that high-dose CBD therapy can improve the quality and duration of sleep.

In addition to showing promise as a safe and effective alternative to conventional psychiatric treatments for insomnia, cannabidiol can reduce symptoms of REM behavior disorder (RBD), which is characterized by the acting out of vivid, intense, and sometimes violent dreams. A preliminary study examined the efficacy of CBD in patients with both Parkinson’s disease and RBD and the results were encouraging.

Obstructive sleep apnea (OSA) is a prevalent form of sleep disorder breathing that affects nine percent of American adults. Research involving animal models of this condition has shown that THC and the endogenous cannabinoid oleamide are effective in reducing sleep apnea events. (Babson 2017) Human studies indicate that dronabinol, a FDA-approved synthetic version of THC, reduces sleep apnea and is safe and well tolerated.

Additionally, cannabinol (CBN), most commonly associated with aged cannabis, is said to potentiate the sedative properties of THC when these two cannabinoids are used together, although this notion may be more modern-day marijuana folklore than scientific fact.

Pain and sleep

Besides the desire for good sleep, treating pain is another common reason for using cannabis. Chronic pain is a major public health issue that directly affects around 20 percent of U.S. adults, many of whom also suffer from diminished sleep. Sometimes it’s hard to know if the pain is causing sleeplessness or if sleeplessness is triggering the pain.

Patients seeking both pain relief and better sleep may achieve positive results with cannabinoids and other cannabis components.4 In their paper “Cannabis, Pain, and Sleep: Lessons from Therapeutic Clinical Trials of Sativex®, a Cannabis-Based Medicine,” Russo et al summarized 13 studies that examined varying cannabis preparations for pain and sleep.

Of particular interest is a Phase II study, involving 24 patients with intractable multiple sclerosis, which compared three different preparations: Tetranabinex (a high THC product); Nabindolex (high CBD); and Sativex® (an almost a 1:1 THC:CBD sublingual remedy).

Different cannabinoid ratios helped in various ways: “Compared to placebo, the CBD-predominant extract significantly improved pain, the THC-predominant extract yielded significant improvement in pain, muscle spasm, spasticity and appetite, and combined THC:CBD extracts (Sativex®) significantly improved muscle spasm and sleep.”

The authors concluded that a combination of CBD and THC (15 mg of each) “improved sleep synergistically.” Of the thirteen studies profiled in this paper, seven showed improvements in sleep. Six of the seven were conducted with Sativex®, the 1:1 CBD:THC sublingual spray, indicating that balanced a cannabinoid profile facilitates sleep improvements among patients with chronic pain.5

The gift of forgetting

The use of cannabis is prevalent among those who suffer from post-traumatic stress disorder (PTSD). A small open trial conducted in Israel showed that 5 mg of smoked THC twice a day resulted in improved sleep and reduced frequency of nightmares in patients with PTSD. (Mechoulam, 2015) This directly correlates with similar test results involving nabilone, a synthetic THC-like drug.

Memory processing occurs when we are asleep, so it stands to reason that someone suffering from PTSD– especially those who experience nightmares – would benefit by using cannabis or cannabinoids to sleep better.

At first glance, it may appear that cannabis is merely a coping mechanism for PTSD patients; it is sometimes negatively characterized this way in the medical literature. Thus far, the majority of studies involving cannabinoids and PTSD have been conducted from an addiction perspective – will cannabis harm PTSD patients and turn them into addicts? – but that may be changing.

Increasingly researchers are recognizing the limitations of the addiction framework, which overlooks the crucial role that the endocannabinoid system plays in helping us forget painful memories, a normal process that is somehow dysregulated when one experiences PTSD.

In some cases, THC and other plant cannabinoids can provide enough relief so that PTSD sufferers are able to embark upon the task of making sense of their traumatic memories and begin the healing process. None of that can happen without quality sleep.

“If you can’t sleep your world goes to hell in a hand basket real fast,” said Al Byrne, a U.S. Navy veteran and medical marijuana advocate.

Many military veterans and victims of sexual abuse are using cannabis to treat their PTSD-related symptoms. A 2016 case study provided clinical data that validated the use of CBD-rich oil as a safe and effective treatment for reducing anxiety and improving sleep in a young girl with PTSD.

Pharmaceuticals provided minimal relief for a 10-year-old girl who had been sexually abused as a young child. And her meds caused major adverse side effects. But a CBD-rich oil regimen resulted in “a maintained decrease in anxiety and a steady improvement in the quality and quantity of the patient’s sleep.”

This is not an isolated example. CBD-rich oil, an increasingly popular treatment for anxiety and sleep problems, has emerged in recent years as a viable alternative to Big Pharma drugs.

Dosing for slumber

Cannabis therapeutics is personalized medicine – and this is certainly true with respect to using the herb and its components to treat sleep disorders. The effectiveness of cannabis as a sleep aid is highly variable, depending on the individual user, how the remedy is administered, its cannabinoid ratio and aromatic terpene profile, the timing and dosage – all these factors come into play and influence different outcomes.

Success may rest upon how well one manages the psychoactive qualities of cannabis. As with any medicine, there are some risks involved when consuming cannabis to sleep better. Short-term use of cannabis may decrease sleep onset latency (how long it takes to fall asleep). But this improvement may weaken over time. Tolerance develops with chronic consumption, which can impair long term sleep quality.

Too much of a good thing can be problematic for frequent recreational cannabis users, who may begin to experience a reduction in slow-wave deep sleep, leaving the individual feeling like they are not well rested. Could this be because recreational users tend to prefer large amounts of THC-dominant cannabis varieties?

Sleep disturbance, ironically, is perhaps the most notable withdrawal symptom when a heavy user stops smoking marijuana. Compared to kicking addictive pharmaceuticals, cannabis withdrawal is a minor discomfort with symptoms typically lasting for a few days (sometimes a few weeks) after cessation. And cannabis, unlike prescription and over-the-counter sleep aids, has never killed anyone.

Medical cannabis users often experience better outcomes with lower doses, especially when they are treating something in addition to sleep disturbances, such as pain, spasticity, or post traumatic stress disorder. Based on the available literature reviewed by Project CBD, it appears that a 1:1 CBD:THCpreparation will most likely confer restorative sleep. Cannabis-naïve patients may find relief with as little as 2.5 mg of THC and 2.5mg CBD. A somewhat higher dose – 5 to 15 mg each of THC and CBD – may work wonders for experienced cannabis users.

The combination of odiferous terpenes present in a given cannabis strain or product can also significantly impact sleep. Individual terpenes have sedating or stimulating effects, thus affecting the sleep-wake cycle. Terpenes can be therapeutic in their own right. As important modulators of cannabinoids, terpenes contribute significantly to how a given cannabis strain or cultivar makes one feel.

Sedating terpenes include terpinolene, nerolidol, phytol, linalool, and myrcene. In addition to causing the infamous “couch-lock” effect at high levels (+0.5%), myrcene can be mildly stimulating at lower levels. Those trying to address pain and sleep issues should consider cannabis remedies that include beta-caryophyllene, as this terpene is also a strong anti-inflammatory and pain-reliever.

Practical Tips for Improving Sleep

In a study published in the Journal of the American Medical Association, 27 percent of respondents indicated that they used complementary, non-pharmaceutical therapies for fatigue and 26.4 percent for sleep deprivation.

Here are a few simple lifestyle modifications and holistic healing options that may improve your sleep quality.

  1. Create an inviting sleep environment. Having a comfortable bed in a relaxing environment is key to quality sleep. Reduce outside or harsh overhead lighting and maintain a comfortable temperature for sleeping. And, reduce noise. If you are a light sleeper consider using a white noise machine to drown out unwanted sound. Salt lamps may help clean the air by reducing negative ions (and provide enough light to get to the bathroom without intruding on sleep).
  2. Have a sleep routine. Going to bed and waking at the same time seven days a week is optimal. Additionally, it is helpful for some people to have a relaxing bedtime routine that lets the mind know it is time to get sleepy. This may include a small warm cup of milk or green tea 45 minutes to an hour before bed, or a few simple yoga stretches to relax, or an Epsom salt bath.
  3. Avoid overstimulation. It is best not to have a television in the bedroom and not to watch violence shows before bedtime, especially for those with adrenal fatigue. Avoid reading or using your phone, laptop or tablet in bed.
  4. Exercise daily. Regardless if your preference is jogging, weightlifting, gardening, walking or tai chi, do some form of exercise every day. But avoid exercising within two hours of bedtime.
  5. Avoid stimulants after 1PM. Caffeine, alcohol, tobacco, certain herbal supplements and drugs may leave you feeling “hyper” and overstimulated, which can impede the brain’s ability to transition into sleep.
  6. Aromatherapy. Many of the sedating essential oil components present in cannabis can also be found in other plants at your local grocery or natural products store, along with misters that spay the oil into the air. Aromatherapy can be relaxing and very helpful to induce sleep. Lavender essential oil, for example, can be help to manage certain sleep disorders.
  7. Use sleep supporting herbs. It is best to work with a healer or someone knowledgeable about herbs and supplements instead of buying whatever sleep cure is touted on the internet. Herbs that have sleep-promoting properties include Valerian, Kava, German Chamomile, Roman Chamomile, Passion Flower, California Poppy, Hops, Lemon Balm, Linden, Skullcap, and Oats. Visit the American Herbalist Guild to find a qualified practitioner.
  8. Nutritional supplements. Consult your physician about products made with Kava, calming minerals, and taking the right kind of magnesium at night.
  9. Other therapies. In addition to cannabis, safe holistic healing alternatives include cognitive-behavioral therapy for insomnia, and bright light therapy for circadian rhythm disorders.


1 In 2014, there were 47,055 accidental opiate overdose deaths. Dr. Daniel Kripke estimates one third of them also involved various hypnotics as a cause of death. It should be noted that cannabis has been shown to improve safety and effectiveness of opiates making it possible for the patient to take a lower dose, thereby reducing the risk of side-effects including death. In some cases, cannabis can replace both the opiate as an effective painkiller and the hypnotic.

2 Highly complex, the sleep-wake cycle is driven by various neurochemicals and brain pathways. Neuroscientist and sleep researcher Dr. Eric Murillo-Rodriguez, says that “Sleep is generated by sleep-promoting neurons placed in the anterior hypothalamus that utilize GABA to inhibit wake-promoting regions in the hypothalamus and brainstem. Then, the brainstem regions inhibited during wake and slow wave sleep become active during rapid eye movement sleep (REM).”

3 In “The effects of cannabinoid administration on sleep: a systematic review of human studies,” Gates et al scrutinized cannabis-related sleep studies prior to 2012. But they found “little consistency in the results [of] six studies with objective sleep measures. Slow wave sleep was described as increasing for a week in one study, whereas three studies reported a decrease in slow wave sleep, and one study showed no change. Rapid eye movement sleep was reported to increase in one study, decrease in a second study, while four studies showed no effect. Stage two sleep [see sidebar] was reported to increase in two studies, while four studies showed no effect. Sleep latency was reported to increase in one study, decrease on a high THC dose in a second study, while two studies showed no effect and two studies did not measure sleep latency.”

4A 2014 article by Babson & Bonn-Miller indicated that over 83 percent of surveyed patients taking cannabis for pain said they experienced improved sleep.

5Nicholson et al had similar results in a double-blind placebo-controlled with a 4-way crossover design study evaluating the effect of cannabis extracts on nocturnal sleep, early-morning performance, memory, and sleepiness in eight subjects ages 21-34 years old. A cross-over design is one where each group of participants take two or more interventions; in this case four different preparations were tested, including THC (15 mg) alone; THC and CBD together (5 mg each and 15 mg each); and a placebo. They scientists found that “although impaired memory was observed the next day when 15 mg THC was given alone overnight, there were no effects on memory when 15 mg THC was ingested with 15 mg CBD.” They also found that the effects of THC and CBD appeared to be dose dependent as evidenced by the fact that 7.5 mg of THC did not impair memory, but 15 mg did.

Copyright, Project CBD. May not be reprinted without permission.


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The Kids Are Alright: Today's Teens Aren't As Into Drugs, Alcohol, or Theft

Tue, 10/31/2017 - 08:00
Teen substance abuse disorders have declined by nearly half in the past 12 years, even as pot legalization spreads and the opioid epidemic festers.

Today’s teens are far less likely to abuse alcohol, nicotine, and illicit drugs, and are also less likely to engage in delinquent behaviors, such as fighting and stealing, according to a study of more than 200,000 teens.

The findings come from the National Survey on Drug Use and Health, an annual survey of 12- to 17-year-olds from all 50 states that is sponsored by the Substance Abuse and Mental Health Administration, an agency of the US Department of Health and Human Services.

The data include information from 2003 through 2014, the last year for which survey numbers are available. A total of 210,599 teens—13,000 to 18,500 each year—were part of the study.

The number of substance-use disorders among 12- to 17-year olds declined by 49 percent over the 12-year span, along with a simultaneous 34 percent decline in delinquent behaviors, such as fighting, assault, stealing, selling drugs, or carrying a handgun.

The drop in substance abuse among teens parallels findings in other recent surveys, but until now no one has looked at how the drop-off may be linked to other behavioral issues.

“We’ve known that teens overall are becoming less likely to engage in risky behaviors, and that’s good news,” says Richard A. Grucza, a professor of psychiatry at Washington University in St. Louis and first author of the study in Psychological Medicine.

“But what we learned in this study is that the declines in substance abuse are connected to declines in delinquency. This suggests the changes have been driven more by changes in adolescents themselves more than by policies to reduce substance abuse or delinquent behavior.”

Previous studies show that teens are delaying sex and using seat belts more often than their parents and grandparents. The new work focused on substance-use disorders—involving alcohol, nicotine, marijuana, opioids, and the abuse of other prescription drugs or nonprescription drugs—and delinquent behaviors.

“It’s not clear what is driving the parallel declines,” Grucza says. “New policies—including things like higher cigarette taxes and stricter anti-bullying policies—certainly have a positive effect.

“But seeing these trends across multiple behaviors suggests that larger environmental factors are at work. These might include reductions in childhood lead exposure, lower rates of child abuse, and neglect, and better mental health care for children.”

Although heroin and opioid abuse have become epidemic in many areas of the United States, the use among teens has fallen, the survey data show.

“Opioid problems continue to increase among adults,” Grucza says. “But among the 12- to 17-year-old population, we saw a drop of nearly 50 percent.”

Based on the survey data, Grucza and his team estimated that in 2014 there were nearly 700,000 fewer adolescents with substance-use disorders than in 2003. And because it’s possible for a person to be addicted to nicotine while abusing alcohol or marijuana, the researchers estimate the total number of substance-use disorders among adolescents declined by about 2 million.

The National Institute on Drug Abuse of the National Institutes of Health supported the work.

Source: Washington University in St. Louis

Original Study DOI: 10.1017/S0033291717002999, 


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Why Should Taxpayers Pay for the Opioid Crisis When Pharma Caused It?

Mon, 10/30/2017 - 13:48
Click here for reuse options! Trump has announced a national public health emergency over opioids for a scourge created by Pharma.

As everyone today knows, opioid narcotics like fentanyl, hydrocodone, hydromorphone, morphine and oxycodone have created a toxic epidemic in the United States with at least 100 daily overdose deaths. This happened because Pharma paid off doctors, medical associations and federal lawmakers to loosen opioid regulations.

There was a reason narcotics were traditionally limited to severe pain cases, not "everyday" pain—they are addicting and can kill, as we are now seeing. But Pharma—especially the Sackler family's Purdue which makes OxyContin—banked on the fact that younger doctors and patients did not remember why narcotics were so heavily restricted. They were right.

As new Pharma-driven prescribing guidelines were drafted and the industry-appeasing FDA waved new pills and patches through despite daily deaths, brazen "pill mills" and "Oxy docs" popped up, as did legions of addicts. Soon "opioid addiction" treatment clinics popped up to play the other side of the street—the addictions caused by the pill mills—further enriching Pharma.

Not only can narcotics like the popular OxyContin, Vicodin, Percocet and the fentanyl patch lead to coma, respiratory depression, shock, pulmonary edema and death, but studies suggest they can increase a body's sensitivity to pain and make pain worse—a phenomenon called opioid-induced hyperalgesia. The drugs also cause constipation, hormonal derangement and negative mental changes.


Many opioid addicts began their downward spiral with opioid prescriptions they should never have been given for chronic pain. Unlike acute pain, chronic pain should seldom if ever be treated with opioids, but thanks to the short-term pill approach of our health care system, it usually is. The cost to society of the opioid epidemic in crime, disability, treatment of addiction and overdoses, lost wages and of course deaths has yet to be fully calculated.

"The problem is, patients are started, develop tolerance, need a higher dose, get tolerant to the higher dose, use more than prescribed, ask for early refills, get switched to a 'pain management specialist,' who if they violate the pain contracts, get fired, discharged, and then they go to the street for the opioids," says James O'Donnell, a pharmacology professor at Rush University in Chicago.

The following medical case from a pharmaceutical textbook shows just how dangerous opioid drugs can be, whether derived naturally from poppies or created synthetically by chemists:

"A 35-year-old divorced male school teacher and wrestling coach in a southwestern state was seen by a sports medicine specialist. He had complained of chronic low back pain, and he had been taking hydrocodone/acetaminophen for the pain. The sports specialist was concerned about acetaminophen toxicity, and prescribed 'low dose' methadone, 10mg twice daily, and discontinued the hydrocodone/acetaminophen. The next day, he stayed at his parent's home. He was very drowsy, sleeping on and off most of the day, and went to bed early. In the late morning of the third day, his mother was unable to awaken him. He was declared dead by EMS."

Trump has announced a national public health emergency over opioids for a scourge created by Pharma. When the extent of damage from cigarettes was revealed, Big Tobacco agreed to cease advertising and to pay, in perpetuity, various states to compensate them for some of the medical costs of caring for persons with smoking-related illnesses. Like Pharma, Big Tobacco said cigarettes "weren't addictive."

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Teen Busted for Pot, Then Raped by New York City Cops

Mon, 10/30/2017 - 10:04
Click here for reuse options! As if we needed even more reasons to end marijuana prohibition.

A New York City grand jury indicted two Brooklyn narcotics officers late last week on charges they raped an 18-year-old woman after arresting her for smoking marijuana. The victim says she was assaulted while handcuffed in the back of a police van in the parking lot of a Chipotle restaurant in September.

The two narcotics officers, Eddie Martins and Richard Hall, face charges of first-degree rape. The victim, who posts on social media under the name Anna Chambers, alleges that both narcs forced her to perform oral sex on them and one of them raped her.

According to Chambers, she and two young men were pulled over by Martins and Hall for smoking pot, and they targeted her after finding prescription drugs in the car. The narcs told her companions to leave before ordering her to undress so they could "search for drugs."

They didn't find any drugs on her, but handcuffed the teen anyway before coercing her into sex, her attorney, Michael David, said.

"You'll spend three hours in the precinct," they allegedly told her. They also allegedly said: "This is what you're going to do for us, and we'll let you go," David said.

"There was zero consent," David said. "The cops were over 6 feet tall. She's very petite, like 5'2" and maybe 100 pounds. There's nothing she could do."

The grand jury issued the indictments October 26 after hearing a week of testimony, including testimony on the stand from Chambers. The narcs were not arrested upon indictment, but are expected to turn themselves in this week. They have been placed on modified duty and stripped of their guns and badges and are now suspended without pay. They're looking at between three and 25 years in prison if convicted.

The detectives, from NYPD's Brooklyn South narcotics squad, have not denied that they engaged in sex acts with Chambers, but claimed they were consensual. They spent the past week trying to discredit and impugn their accuser.

In a letter to prosecutors, lawyers for the narcs pointed out she had filed a $50 million claim against the city in October and had posted "provocative" selfies on her Instagram and Twitter accounts after the assault. The lawyers called on prosecutors "to further investigate Chambers' dubious claim before you ask the grand jury to return an indictment against Martins and Hall."

Chambers furiously rejects the narcs' claim that the sex was consensual, her lawyer said.

"She was shocked that the [cops] would say it was consensual after everything that was done to her. She wanted to get the word out," David told the New York Post. "She just wants everybody to know it's an absolute lie that this was consensual. She was raped. She was viciously, brutally raped in handcuffs. It's the truth," he said.

"She's embarrassed," David continued. "She's very depressed over this. Her whole life had changed after this experience. She's afraid of the police, and she really wants justice to be served here."

After the attack, Chambers did what victims are supposed to do: She sought help at NYU Langone Hospital, which performed a rape kit on her that found the cops' DNA. She reported the sexual assault to police. She confided in friends about the assault, and she filed a civil lawsuit. And now, the criminal justice system swings into action against the perpetrators.

One of the reasons the war on drugs is so loathed is that it provides the opportunity for crooked cops to abuse their power in ways like this. One wonders how many similarly abused women have not come forward. 

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Opioid Epidemic Shares Chilling Similarities With Past Drug Crises

Mon, 10/30/2017 - 08:35
We've been here before, and there are lessons to be learned.



Opioid epidemic shares chilling similarities with past drug crises

NEW YORK (AP) - While declaring the opioid crisis a national public health emergency Thursday, President Donald Trump said: "Nobody has seen anything like what's going on now." ... , an outcast in a society of outcasts. He is regarded as a fool by heroin addicts, as insane and violent by those using psychedelics and marijuana, and a ‘bust' by non-drug using hustlers," wrote Dr. Roger Smith ...{C}

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Marijuana Can Help The 12 Million Patients Suffering From Spasticity

Mon, 10/30/2017 - 08:19
In Canada, 1 in 5 of MS patients currently use medical marijuana.

Could cannabis be the new, improved answer for patients suffering from spasticity? The roughly 12 million people worldwide who are thought to suffer from the condition would love to hear that news. Spasticity, like it sounds, refers to a variety of involuntary muscle spasms and stiffness. It is a very common symptom of multiple sclerosis, but it can also be the result of other conditions such as cerebral palsy, stroke and brain or spinal cord trauma. 

Using cannabis for calming muscles is not a new approach. In the mid-1840s, before prohibition, physicians prescribed cannabis tinctures and extracts for inflammation, muscle spasms, delirium tremens (DTs) and a host of other conditions.

The traditional modern treatments for spasticity includes use of muscle relaxants like baclofen, injecting people with botulism and physical therapy. Sometimes the situation is so dire that the patient even resorts to surgery to implant muscle relaxant pumps and to permanently sever the roots of nerves.

Times and approaches change. Since 2010, Canadian patients have had access to Sativex, a prescription combination of THC and CBD in a peppermint flavored oral spray. 

A large study looked at the use of Sativex by over 900 patients in the UK, Germany and Switzerland with treatment-resistant multiple sclerosis spasticity. The patients were given the drug for daily dosings and evaluated to see how well they maintained their therapy regimen. The study revealed that 68 percent of the patients voluntarily stayed on their cannabis medicine at least one year. An additional 207 Spanish patients in specialized MS centers had equally successful “continuation rates” of staying on the cannabis-based medicine.

Additionally, German researchers studied 16 young patients ranging in age from 1 to 26 with “complex neurological conditions with spasticity.” The subjects were given daily drops of a synthetic cannabinoid, dronabinol (Marinol). Researchers concluded that “in the majority of pediatric palliative patients, the treatment with dronabinol showed promising effects in treatment resistant spasticity.” 

It’s not magic, but it may feel that way to people whose conditions have been hard to manage and have not had success with other therapeutic approaches. THC is believed to engage the endocannabinoid system to block inflammation and improve the natural communication between muscles and nerves. Some researchers believe that this reduction in inflammation can even slow the progression of the disease and the increasing disability it creates.

The good news is that the word is spreading about the potential impact of cannabis on spasticity, particularly among the MS patient community.

In Canada alone, one in five MS patients currently use medical marijuana in some form. For these patients and others who experience the debilitating condition of spasticity, this is hope, and hope is profoundly important.

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Here’s What Donald Trump Should Have Said About Opioids

Mon, 10/30/2017 - 06:39
Click here for reuse options! The harm stops here.

My Fellow Americans,

Families, communities, and citizens across our country are in crisis due to the dramatic escalation in opioid overdoses. While some other countries are struggling with increased overdose rates, the problem is far worse here. And it’s time that we ask ourselves why: Why is it that after billions of dollars spent on trying to stop illegal drugs from coming into the US, today opioids are as plentiful as ever? Why is it that decades since Nancy Reagan urged American kids to “just say no,” demand is as high as ever? And why are so many people dying?

A big part of the answer is that the war on drugs has failed to deliver on its promises.

Arresting and locking up people who use drugs has only driven them underground, making it less likely they’ll seek help when they need it. The lack of meaningful public education about drugs, their real effects, and the concrete risks around them — for example, that the risk of death goes up when opioids are mixed with alcohol — means that those who try drugs are likely to do so in riskier ways. The criminalization of drugs means it’s impossible for people who use drugs to get their supply tested, and to find out whether it’s adulterated with unwanted substances like fentanyl.

The billions of dollars we have poured into going after the drug trade, both abroad and at home, have only enhanced the profitability of the drug market for organized crime. As a result, criminal groups have near-limitless financial resources to develop ever more inventive methods to keep the supply going, to corrupt authorities, and to ruthlessly protect their share of the market.

The "collateral damage" of this unwinnable war? Devastated families across the US.  Not just the families of the 64,000 people who died of an overdose in 2016, but the countless others, particularly in communities of color that have been aggressively targeted by police, whose loved ones have been locked up or deported for low-level drug offenses. Abroad, the cost has included hundreds of thousands of people killed in countries from Mexico to the Philippines.

Rather than solving problematic drug use, the war on drugs has metastasized into a decades-long national and global disaster. It has criminalized a public health issue and inflicted death, incarceration, and untold billions in wasted US tax dollars on multiple generations of Americans. Enough is enough.

I’m here to propose a different approach.

Today, I am officially declaring the opioid crisis a national public health emergency under federal law.

We will never be able to stop all people from using drugs, and we shouldn’t try. Our goal should be to minimize the harms — like overdose — that can flow from drug misuse, while avoiding causing greater harms in the process.

We will take immediate action to prevent overdose by funding community-based programs to provide the life-saving overdose-reversal medication naloxone, working to lower its price, and removing barriers to accessing it elsewhere. We will work with states so they improve, pass, and implement Good Samaritan laws, and stop  prosecutions of people who are present at the time of an overdose. Nobody should be afraid to call 911 to save a life.

We will not coerce people into treatment through criminal justice tools or drug courts, as too often that only does further harm by landing people in prison. For those who want it, we will increase access and eliminate red tape around evidence-based treatment, including the medications methadone and buprenorphine, which have proven far more effective than other options. We will put resources into researching and evaluating new treatment and pain management modalities, including medical marijuana.

We will promote mechanisms that have proven effective to reduce the harms associated with drug misuse. That includes safe consumption facilities, where people who use drugs can consume them under the supervision of trained professionals, who can monitor them for overdose and refer them to treatment or other support as needed. We will provide free drug checking services in communities across the country, so people who use opioids can ensure they’re not adulterated in ways that increase their risk.

Rather than resort to fear-mongering, we will equip our young people with knowledge, warning them about the risks of drug misuse in a realistic and scientifically grounded way. We cannot control all their choices, but by treating them with respect and giving them sound information, we can ensure they have what they need to make good choices for themselves.

Right now, we will stop putting law enforcement resources into arresting people for drug use and possession. We must stop treating people who use drugs as criminals, and stop using the war on drugs as an excuse for persecuting Black, brown, and immigrant communities. Instead, we will invest those resources in addressing the many other needs of the communities that have been worst hit by the war on drugs — particularly among people of color.

It will take many years and even decades to undo the terrible harms wrought by the war on drugs, but we must start in earnest now.

The harm stops here.

This piece first appeared on Salon

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There's a Man Serving Life in Prison for $5 Worth of Marijuana in the Same Country Where Millions Can Smoke It Legally

Fri, 10/27/2017 - 13:35
Click here for reuse options! The madness of the drug war is far from over.

Deedee Kirkwood is a hippie housewife in Camarillo, a scenic beach town in California outside of Los Angeles. When she was younger, she followed the Grateful Dead on tour and says she smoked copious amounts of pot “before and after." But her youthful indiscretions had no legal consequences. “I did a lot of stupid stuff, but as a white lady I got lucky,” she tells me over the phone.

Kirkwood often writes letters to Fate Vincent Winslow, an inmate in the Louisiana State Penitentiary. He’s not as lucky as she was. In 2008, Winslow was homeless on the streets of Shreveport, Louisiana. One night, an undercover cop approached and asked him for “a girl” and some pot. Winslow got two dime bags of weed from a white dealer he knew and sold them to the officer. In all, he made five bucks from the sale, money he needed to buy food, he says.

Police arrested Winslow, but not the dealer, even though he’d profited more handsomely from the sale; the marked $20 bill was found on him.

During Winslow's trial, prosecutors pointed to his long criminal history as a reason to put him away. But court records show he was far from a criminal mastermind. He had two nonviolent priors and a drug charge, which is not uncommon for poor people living on and off the streets. Still, after the predominantly white jury voted guilty, he was deemed a habitual offender. Under Louisiana law, that meant an automatic sentence of hard labor without benefit of parole, probation or suspension of sentence.

“I just keep praying I know everything will be all right,” Winslow writes in a letter.  

“There are people serving life for marijuana,” Deedee Kirkwood says. “When I tell people about this, they don’t believe me.”

It does defy plausibility, even in the context of the American criminal justice system, which is hardly famous for being rational or sane. According to the ACLU’s “A Living Death” report, as of 2012, 3,278 people were serving life without parole for nonviolent crimes—and that’s just federally and in nine states. The states that have locked away the most people per capita are Louisiana, Florida, Alabama, Mississippi, South Carolina, and Oklahoma.

Even at a time when more Americans support pot legalization—a Gallup poll released Wednesday found that 64 percent of Americans want legal weed—Fate Winslow is not the only person serving an absurdly long sentence for marijuana.

“Most people are shocked to hear that there are people serving a life sentence for pot, but there are many,” says Amy Povah, a former prisoner who now runs CAN-DO, an advocacy group for nonviolent drug offenders. Povah recalls doing a vigil outside of the White House for drug offenders serving long sentences. A passerby asked which country’s brutally oppressive regime she was protesting. He was surprised to learn she was there to draw attention to America’s prisons. 

A slew of factors contributed to long sentences for drug crimes, but it mostly comes down to aggressive prosecutors and the legal tools lawmakers have given them in the past few decades. There are the mandatory minimum and habitual offender laws passed at the height of the crack panic in the 1980s and 1990s. Because of mandatory minimums, often well-meaning reforms end up empowering police and prosecutors in ways that target people of color and poor people at disproportionate rates. Take gun charges; aggressive prosecutors can stack up gun charges to inflate sentences for nonviolent drug crimes.

Michael Thompson got 40-60 years after selling a few pounds of weed to a police informant in a sting in 1994, in part because some guns were found in his house (two were antiques and one allegedly belonged to his wife). He’s still in prison in Michigan, despite lobbying on his behalf by his nephew Sheldon Neeley, a Democratic congressman in the Michigan house. “I've been here over 22 years over marijuana,” Thompson told me over the phone in disbelief. “Twenty. Two. Calendar. Years.”

During that time his mom died; he attended her funeral in chains. Her last wish was for her nephew the congressman to make sure her son didn't die in prison.

Another reason someone might get a long sentence for marijuana crimes is through the use of conspiracy charges. That’s what happened to John Knock, a 70-year-old federal prisoner serving life without parole in New Jersey. His sister, Beth Curtis, who advocates on his behalf, explains how conspiracy charges can trigger an automatic LWOP sentence. “If you know anything about the 1960s…people didn’t go to prison for doing lots of things that they get buried for now,” she says. Her brother did take part in a marijuana smuggling operation, but by the time he was indicted, he was no longer involved in selling drugs. Yet, because of how conspiracy charges work, he was on the hook for all the drugs sold over the years by others involved in the operation. “Everything that was done by anybody during that time was attributed to him when he was indicted,” she says.

What Can Be Done?

Families Against Mandatory Minimums, CAN-DO Clemency and the Drug Policy Alliance are just a few of the groups and activists advocating for the release of prisoners serving long sentences. Civil liberties groups like the ACLU and Human Rights Watch have documented their plight for decades. Individual activists like Deedee Kirkwood write to prisoners like Fate Winslow because they can’t stand the injustice of people serving prison sentences for what she calls “a harmless plant.” Anything from dropping a few dollars into a prisoner’s commissary to writing letters to setting up with legal aid can help, as well as lobbying state governors to commute individual sentences while promoting more systemic reforms.

In the last year of the Obama administration, criminal justice reformers mobilized to lobby the Justice Department to grant as many commutations for nonviolent crimes as possible. Critics pointed out at the time that with the “law-and-order” Donald Trump about to get in the White House, the administration should have released more prisoners. At this point, their only chance is presidential clemency for federal prisoners, while people serving long sentences in state prisons can hope for a commutation from their governor.

Because both Republican and Democratic governors have to balance budgets, the call for criminal justice reform tends to be more bipartisan than most issues at the state level. But many states are starting from such an extreme point that even commutations or broader reforms end up relatively conservative. In one striking example, in 2017 Oklahoma Governor Mary Fallin changed the sentences of several drug offenders from life without parole to life with parole. One of them was William Dufries, who got caught with 67 pounds of marijuana in his RV after being pulled over because of a broken tail-light.

Most people who end up in jail over marijuana don’t get life. But even a short stint in jail that results in a record can mean years of financial and personal hardship.  A 2016 report by the ACLU and Human Rights Watch found that marijuana arrests still outnumber arrests for violent crimes, entangling people in the criminal justice even for simple possession. In 2015, almost half of drug possession arrests were for weed (over 574,000), the study found. Even states with a thriving legal industry have failed to erase racial disparity in pot arrests; a 2016 NPR report found that minority teens were getting busted at even higher rates than before.

As support for legal weed continues to grow, what does the industry owe people serving time for marijuana? Tom Angell, a journalist and legalization advocate, points out that there’s a lot more drug advocates could be doing. “Even when we succeed in ending prohibition, our work isn’t done,” he writes in an email. He points out that the industry must look beyond legalization. "In addition to remaining forms of discrimination against cannabis consumers in the areas of employment, housing and child custody, there are still people serving time behind bars for things that are now legal.”  

A few leaders in the weed community have advocated for criminal justice reform. Terra Tech CEO Derek Peterson has worked to get criminal justice reform language in legalization bills in New Jersey. San Francisco’s Nina Parks, who runs Mirage Medicinal, has spoken out about the need for reform; her own brother spent a year in Rikers after getting busted with weed in New York.

“We have to do our best to encourage policy that helps to heal the effects of targeting poor ethnic communities had on our culture,” she told "While ensuring that there is a diverse and equitable industry and regulatory structure that really cares about public health and safety vs feeding a prison industrial complex.”

Despite Attorney General Jeff Sessions’ cranky antipathy against marijuana, a federal crackdown on the weed industry in states where it’s legal doesn’t seem imminent. Analysts who study pot markets have voiced concern that the threat of federal flexing on the issue might chill growth, if, for example, the prospect of more civic asset forfeiture actions spook business people or investors.

But overall, there’s not much evidence that a Sessions Justice Department has dampened enthusiasm for legalization. The Gallup survey released this week (referenced above) found that for the first time, even a majority of Republicans support marijuana legalization.

Even if the Sessions DoJ did shake up markets for a bit, that’s a far cry from dying in prison for a drug most college kids can get any night of the week by texting their weed delivery guy.

When I asked Fate Winslow in a letter how he felt about the fact that a drug that landed him in prison for life without the possibility of parole is now the basis of a million-dollar industry, he pointed to one obvious difference between legal pot entrepreneurs and himself.

“Those people have money,” he wrote.

Still, he’s surprisingly gracious that America seems to be evolving on marijuana, adding in his letter, “I don’t want no one else to have to go through this. I been locked up nine years for two $5 bags of weed that I didn’t even sell. I have life left to go.”

One of the biggest criticisms of life sentences is that they kill hope. If nothing you do can atone for your crimes, what’s the point of bettering yourself? Fate Winslow hasn’t given up yet. He’s taking classes. But it’s not easy for him to stay positive. He says he just keeps praying and tries to trust in god, even though he feels like god doesn't care much about him.

When he writes Deedee Kirkwood, he asks about her grandchildren and compliments her family. He thanks her profusely for the card she sent, because it made him feel he wasn’t completely alone on his 51st birthday. He loves peanut butter, and the money she sent to his commissary allowed him to indulge in that rare treat for his birthday.  

“I am still doing everything I can to get out of here,” he writes. “So keep praying for me.”

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TV News Has an Ugly Role in the Pharma Epidemic That Has Killed 200,000 Americans

Fri, 10/27/2017 - 13:19
Click here for reuse options! There's a virtual TV media blackout on the topic of Pharma's role in the crisis.

Over the two years covered in the explosive 60 Minutes/Washington Post joint-investigation “Ex-DEA Agent: Opioid Crisis Fueled by Drug Industry and Congress,” there was no coverage by any major TV news outlets of the four versions of the bill or its final signature by President Obama.

In a year of depressing stories emanating from Washington, the sheer scope of DC culpability in a scandal that helped fuel the greatest drug epidemic in American history is stunning. As Big Pharma and Congress moved four versions of the Ensuring Patient Access and Effective Drug Enforcement Act forward, from the first House version in February 2014 to Obama’s signature of the fourth and final version in April 2016, TV news media was silent. There were no stories on the actual negotiations, on Big Pharma’s role in creating the crisis, or the lobbyist rationale for defanging the DEA.  

President Obama signed the legislation quietly behind closed doors, a clear red flag in Washington. Attorney General Loretta Lynch and pharma-pliant DEA Chuck Rosenberg played along and both houses of Congress approved the final versions with unanimous consent. Big Pharma and its army of lobbyists made a full-court press over many years and their efforts were rewarded handsomely. According to the Washington Post "John Mulrooney, the chief DEA administrative law judge, has been documenting the falling number of immediate suspension orders against doctors, pharmacies and drug companies. That number has dropped from 65 in fiscal year 2011 to six so far this fiscal year, according to the DEA. Not a single order has targeted a distributor or manufacturer since late 2015.”

All of them have blood on their hands.  

The final versions of the bill were approved in the House and Senate with unanimous consent. There is little daylight between the Democratic and Republican parties when it comes to Big Pharma, which contributes to the campaigns of candidates on both sides of the aisle. When the Ensuring Patient Access and Effective Drug Enforcement Act was being negotiated from 2014 to 2016, there was ample documentation available to Congress members on the drug industry fueling opioid addiction.


As reported in excruciating detail in “The Family that Built an Empire of Pain,” Patrick Radden Keefe’s recent New Yorker article chronicling Purdue Pharma and the founding Sackler family, Purdue senior executives were convicted and heavy fines were paid as far back as 2006. OxyContin and other opioid-based pharmaceuticals fueled the staggering growth in pain medication sales and abuse, behind one of the most aggressive marketing efforts in pharmaceutical history. The link between prescribing opioid painkillers and the opioid crisis was undeniable. And everyone in Washington knows it.  

When they do report on drugs, TV news media spend more time on Prince and celebrity deaths than on drug policy that affects millions. More time on state marijuana laws than far more deadly federal opioid-prescription legislation. More time discussing how El Chapo escaped from prison than how to put devious prescription distributors and pharmaceutical drug-dealers behind bars. More time on how to clean up the mess than on how to stop the flow. And with drug commercials a mainstay of TV broadcast and cable news programming, it is easy to understand why the topic rarely surfaces.

Andrew Tyndall, who tracks ABC, NBC and CBS Evening News programs on Tyndall, kindly provided search results for his narcotics category and returned 149 stories on the three networks from Feb. 1, 2014, to May 1, 2016.

Many stories each on Bill Cosby, El Chapo, Philip Seymour Hoffman and Prince; many gut-wrenching tales of addicts, families, first responders, communities, courts and police battling the epidemic. And a whole bunch of stories on medical marijuana and pot legalization. But not one story on pharmaceutical drug policies or laws enacted at the root of the opioid crisis.

Except one—ironically, a Feb. 27, 2014, NBC News story on FDA approval of a new painkiller, Zohydro ER, which is five to 10 times more powerful than hydrocodone. Senior-level FDA officials during the Obama administration approved the painkiller over the FDA’s Advisory Board recommendations, which are normally followed.

The Ensuring Patient Access and Effective Drug Enforcement Act went through many versions over a two-year period, and there were ample opportunities for TV news to report and investigate. The House passed a first version on Feb. 18, 2014; a second version passed on July 29 and was opposed in a press release by then Attorney General Eric Holder.

I was unable to find TV news coverage of any versions of the legislation on the major network evening news programs and cable news channels during the two-year period the bill was negotiated by Congress.

A third version, H.R. 471, passed the House via unanimous consent in April 2015, and a Senate version sponsored by Senator Orrin Hatch, R-I, S 483, passed with unanimous consent in March 2016. In quick succession, the House approved the Senate version and President Obama signed it into law on April 19, 2016. TV news was nowhere to be found.

CNN found time to cover DEA prostitute parties, Lindsay Lohan, Philip Seymour Hoffman and even Randy Quaid, but no coverage of laws or drug policy that might actually stem the epidemic. MSNBC had 41 stories with “prescription drugs” in the transcripts on their core evening programs, but also failed to cover any of versions of the scandalous bill.

There was a big raid by the DEA in May 2015, with the arrest of 48 doctors in four southern states illustrating the excesses in the delivery chain of prescription drugs. But our TV news organizations rarely investigate or dig into the weeds of slow-moving legislation, and the bill moved forward under the TV news radar.  

I watched an ABC 20/20 program broadcast during the bill's gestation called “Breaking Point: Heroin in America.” It follows a common drug documentary pattern, focusing on heart-wrenching stories of addicts, desperate families, exhausted police forces and treatment facilities under siege. The focus was on the opioid “fire” and the victims and first responders, not the prescription “fuel” supply driving the epidemic or how to stop it.

Another documentary during this period, “Chasing Heroin,” a two-hour Frontline documentary, written and directed by Marcela Gaviria, was far more pointed in describing how the epidemic began as a result of Big Pharma. The doc solidly describes how Perdue convinced the FDA to allow Oxycontin to claim it “might be less addicting.” After this lie was revealed, Perdue paid $600 million and revised the product with new “abuse-deterrent properties." But the rest of the documentary never returned to Big Pharma or efforts to reduce the supply.

As of this writing, the only change since the explosive 60 Minutes/Washington Post investigative report was that Rep. Tom Marino (R-Pa.), who sponsored the bill, has removed his name from consideration for drug czar. We will see if other sponsors of the legislation suffer at the polls, or whether an effort to remove the law will garner any support.

TV news continues to focus on the heartbreaking individual stories of addiction, the damage opioids have wreaked on our communities, and how doctors, clinics, courts, police and first responders are dealing with the crisis. While well-intentioned, their failure to confront the root causes—Big Pharma, its lobbyists and the laws that enable them—will doom us to a continuing cycle of misery. We need Big News to step up and do more. It’s the crisis in our backyards. There will be no solution until we curtail and rethink the pharmaceutical pipeline.  

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Why a Grandmother Went to Rural Texas and Used a Frog Secretion to Rid Toxins from Her Body

Fri, 10/27/2017 - 07:29
Click here for reuse options! Amazonian "sapo" tree frog medicine is making its way out of the jungle.

Kimberly Chilcote, a grandmother of five, came to this tiny Texas town from Tucson to learn how to heal others with sapo—an Amazonian medicine derived from a tree frog, found in Bolivia, Brazil, Colombia, Peru, Venezuela, and the Guianas.  But first, she must be healed.


The air in the room is filled with the smell of Florida water. The medicine man sits in the corner, chanting and shaking a shacapa, a rattling leaf bundle. Chilcote puts protection oil on herself, and then the medicine man takes a tamishi vine stick, and burns three holes in her upper arm. He peels back the burned skin. On a long, flat, hardwood stick, there is a dried, clear lacquer-like substance, taken from an Amazonian tree frog.  Using a knife, he mixes it with his own saliva into a froth that looks like egg whites. Then, using the knife, he applies it to her burned flesh. 

Within minutes, Chilcote, 46, is sitting, shaking a rattle, and the medicine man is singing a prayer of healing over her. Her face flushes, her chest heaves. Her cheeks swell—frog face, they call it. Then she vomits into a bag.

After a few minutes, the medicine man feels her forehead. She is warm, and he asks if she’d like some water. She nods, and he gently pours water over her head. It drips down, and she sways. Fifteen minutes later, she’s laughing.

Sapo, also called kampo or kambo, is made up of the secretions of the Phyllomedusa bicolor frog. This giant waxy monkey tree frog is found in aquariums throughout the U.S.—but the frogs in captivity don’t secrete sapo. The process of sapo collection does not harm the wild frogs. The frogs are captured for the collection process, then released back into the wild.

Traditionally, sapo is used by the Matsés people of the Peruvian Amazon to sharpen their senses, improve their hunting skills and to be able to take long walks without hunger, thirst or exhaustion. They also use it to watch the development of a fetus.

Peter Gorman, a journalist and chef, is also the medicine man (my words, not his) who has written about experiencing sapo, and was perhaps the first non-indigenous person to bring it out of the jungle. He is the one teaching Chilcote about the sapo. 

Sapo isn’t traditionally given in a ceremony like the one he performs, but he does so because, he says, sapo is abrupt and ceremony can ease people into the experience, where they otherwise might panic from the first come-on of the substance in their system.

Sapo, says Chilcote after a few days of receiving the medicine, “is a group of many different peptides and amino acids that interact with our system. They cross the blood-brain barrier, and have a strong effect on the pituitary gland.”

Sapo isn’t scheduled by the Controlled Substances Act, and it’s not illegal in the U.S.

People claim the effect of sapo is an intense physical, emotional and spiritual experience that lasts about 15 minutes. Those who have taken the medicine report feeling clearer, sharper and better in the days following its administration. While some people will brag about how much sapo they’ve "done," each dose and experience can be different, and dosage isn’t determined by weight or body size. 

Chilcote believes sapo may be good for cardiovascular conditions, mental and emotional issues, and cancers. It’s gotten some attention for addiction cessation, but treatment for addiction would not typically occur with a few sessions of sapo alone. Chilcote says the sapo “pulls toxins from wherever we store them." 

Chilcote says a good candidate to use sapo depends on the kinds of medications a person is on and their stability and history. She note a person on chemotherapy drugs or with a history of extreme violence, among other things, might not be the best candidate for the medicine. And Gorman stresses it should not be used by pregnant or breast-feeding women.

There are practitioners around the country who are reasonably public about sapo use. Some have studied in Brazil, or with Gorman in Texas.

People should not order sapo online and should never self-administer a substance with no verified uses that may or may not be the real thing.

After the purge of the sapo, the body needs to rest, says Chilcote. But then there is “a clarity.” 

“It comes on fast and hard and it’s brutal for 15 to 20 minutes. You are sure you’re dying, and then there’s a break, and you realize ‘I just made it through,’ and it feels beautiful. It’s brutal, and then beautiful. You feel clean and clear.”

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The Discreet Personal Marijuana Cultivator: 3 Tips for Keeping Your Home Grow on the Down Low

Thu, 10/26/2017 - 10:50
Click here for reuse options! You may be able to legally grow your own pot plants, but that doesn't mean you necessarily want the world to know.

Okay, so you live in a place where you can grow your own marijuana plants without fear of arrest and now you want to take advantage of your newfound freedom. You still have good reason not to advertise what you're up to, and we have some tips for keeping that home grow away from prying eyes--and some nice illustrative photos.

Even if marijuana is legal, not everyone approves, and at the same time, others may find the fruits of your labors tempting. Whether it's nosy neighbors, sticky-fingered area teens (who'll be doubly sticky-fingered if they're messing with your budding plants), or local officials waving ordinances and citation books, there's no need to advertise what you're up to.

There are some relatively easy steps you can take to keep that grow on the down low. I employed all three of the following in my own three-plant personal grow. (The harvest is still curing, but it looks like I'm going to end up with four or five pounds of manicured buds by the time all is said and done—enough to keep me out of the pot shops and make some of my friends very happy, too.)

1. The Screen of Green

Sometimes, building a fence is just too obvious. Faced with an open field and an office building parking lot behind where I wanted to grow, I hid my plants from prying eyes by constructing a framework on which I could support plantings of corn and scarlet runner beans. It was cheap and easy: I screwed 8-foot 2x4s into some saw horses, then set 6-foot bamboo poles into the ground about a foot apart along the 2x4s. I then tied the poles to the 2x4s and ran lengths of twine horizontally across the poles so plants would spread not just up, but across the framework.

My green screen was just a simple straight line, but you can shape it as needed. You could make an angled wall o' green to block the view from a couple of angles or even a complete square—depending on where you need to obscure visual access and how much room you have.

Above, you can see the simple construction framework of sawhorses, 2x4s, and bamboo poles. This is early in the screen's life, before leaves spread out everywhere.

Above, the green screen in full bloom. Do you see the pot plants behind there? Neither do I. 

And here's what's behind the screen: One OG Kush plant on the left and two Sour Diesels.

2. Backgrounding

If you're going to grow bright green plants, camouflage them by growing them in front of a variety of other green plants. Bushy marijuana plants on a barren field are going to shriek out their presence, but surrounding your plants with other greenery is going to make them look like they're just another part of a verdant ensemble.

Above, note the greenery around and behind the pot plants. It helps them blend in, and you can do it better than I did. 

3. Grow Low

For your personal grow, you don't need 12-foot-tall monster pot plants. Just one of them is going to produce more weed than you'll know what to do with, and 12-foot pot plants stand out like, well, 12-foot pot plants. Note that the plants I grew are no more than four feet tall. I kept them short not by starving them of water or nutrients, but by pruning the main stem, which causes them to bush out, not grow upward (as much as if left alone). Shorter plants are easier to obscure amongst the surrounding foliage.

If you're really dedicated, you can physically train your plants to grow more sideways than up by tying down branches. But this kind of plant body modification requires daily attention and daily tying down of new growth. The cool thing is, if you do this, you can end up with a row of flowering colas popping up in a row along a horizontal branch. 

Above, note that these colas are all barely above the height of the 2x4s on the green screen framework. Shorter plants are less visible plants. 

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Marijuana 101: 5 Tips For Choosing The Best Edible For You

Thu, 10/26/2017 - 09:51
Some pointers to get you where you want to be. 1. Ask Yourself: Do I Want To Get High?

You can filter out a bunch of edibles by deciding if you want to get super high or hella relaxed.

If it’s a high you’re after, you want to chose edibles infused with THC. Want a mellow vibe? CBD, often found in liquid edibles, is what you’re after.

2. Ask Your Budtender For Help

Simply walk into your nearest retail shop and ask the person working behind the counter what they recommend. A good budtender has tried most of the edibles he sells, if not all of them.

They’ll also be very helpful when it comes to dosing. If you’re new to consuming edibles, let them know so they don’t recommend a high dose. Even experienced smokers will find that edibles pack a bigger punch. Start with 5 mg.

3. Research

The internet is your friend. Do a search on “Best edibles in (your city)” and you will likely be supplied with an outpouring of information, from guides to your local pot shops to customer input via Reddit, Yelp and Thrillist.

Everyone’s got an opinion on edibles. It’s not hard to find.

4. Trial & Error

The best way to find out what you like is by taste-testing. Everything can be infused with marijuana these days, including cocktail mixers, wine, and coffee.

Spend a weekend hitting up your local retail shops and picking out some items and trying them out with some friends. Or by yourself during a Netflix bing.

5. Make Your Own

When all else fails, make your own. This way, you can control the dosage and make foods you actually want to eat while saving some hard earned cash. It can be as easy as adding an infused oil.

Recipes are everywhere. Just make sure you get yours from a reputable source. Or ask your friends if they have any recipes they’ll share with you (in exchange for some final product).


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