Drug News in Brief

Short takes on matters various.

Taking Aim at Pot—Researchers have recently made clinical efforts to test three drugs that might help during marijuana withdrawal to keep pot abstainers on the straight and narrow. Researchers at Columbia University, led by Margaret Haney, have been testing a synthetic THC compound called nabilone. The drug is designed to address sleep and appetite problems during withdrawal.  Whether it is any better tolerated by users than Marinol, Uncle Sam’s widely unpopular version of synthetic THC, remains to be seen. This approach can be viewed rather like methadone or buprenorphine substitution therapy. Meanwhile, work goes on with lofexidine, a drug sometimes used in combination with naltrexone for opiate detoxification. A 2008 study in Psychopharmacology showed a modest improvement over placebo when lofexidine was used for marijuana abstinence, but it worked much better when combined with, yes, synthetic THC. Finally, velafaxine, better known as the antidepressant Effexor, was used in a randomized, double-blind, placebo controlled trial of marijuana-dependent outpatients recently published in Addiction. Not only did velafaxine fail to help the patients with their cannabis dependence, but in fact “may lead to an increase in cannabis use.”

Smoking is Bad to the Bone—The Journal of Adolescent Health reports that cigarette smoking dramatically impacts the rate of bone density growth in teenage girls. Young women may be smoking their way toward a future of osteoporosis, the loss of bone density that often plagues older women. “This age group is when you should gain about 50 percent of your bone accrual,” reports study author Lorah Dorn at Cincinnati Children’s Hospital Medical Center, in Science News. A 2001 study of adult smokers found that smoking increased the risk of hip fracture by 31% in women. In addition, at the recent annual meeting of the American Academy of Orthopedic Surgeons, researchers reported on a study of 6,779 patients undergoing treatment for spinal disorders with severe pain. Those who quit smoking during treatment reported greater pain improvement than patients who didn't stop smoking. 

Dr. Google Will See You Now—Researchers are starting to data-mine the Internet to identify unanticipated side effects and interactions between prescription drugs. According to an article in Science by Sean Treacy, one study in 2011 data-mined reports to the FDA from doctors, nurses, and patients, and “uncovered a hidden drug interaction: When taken together the antidepressant paroxetine and the cholesterol suppressant pravastatin can cause hyperglycemia, or high blood sugar.”  Bioinformatics researcher Nigam Shah of Stanford told the magazine that “if a lot of people are concerned about a symptom, that in itself is valuable information.”

Fetal Health—Scientists have traced out a molecular signaling pathway that appears to play a crucial role in the development of fetal alcohol spectrum disorders (FASD). According to the researchers, whose study was published in the Proceedings of the National Academy of Sciences, “ethanol may cause FASD in part by decreasing the adhesion of the developmentally critical L1 cell adhesion molecule through interactions with an alcohol binding pocket on the extracellular domain.” In English, it means that the research points to strong candidate genes, therefore identifying a specific locus of action for future drugs designed to block alcohol neurotoxicity in the womb. A group led by Michael Charness at Harvard Medical School did the work, building on previous studies that identified the alcohol sensitivity of L1 adhesion molecules. “Prenatal alcohol exposure is the leading preventable cause of birth defects and developmental disorders in the United States,” according to perennial Acting NIAAA Director Kenneth Warren, in an NIH news release.

Photo Credit:  http://jimbaker.wordpress.com/

Marijuana Withdrawal? What Marijuana Withdrawal?

AlterNet article calls pot addiction "laughable."

Wondering why you're feeling anxious, sleepless, irritable, sweaty, and scared when you stop daily pot smoking? Don't worry, Paul Armentano has the answer: You're full of bullshit.

Armentano, in an article for AlterNet entitled "B.S. on the idea of 'marijuana addiction'," asserts that "there's little consensus that such a syndrome is clinically relevant -- if it even exists at all."

The proof? "According to state and national statistics, up to 70 percent of all individuals in drug treatment for marijuana are placed there by the criminal justice system. Of those in treatment, some 36 percent had not even used marijuana in the 30 days prior to their admission. These are the 'addicts'?"

No, these are not necessarily the addicts. These are people undergoing mandatory treatment dictated by the criminal justice system. As Armentano points out, they may or may not have been using drugs before their court-mandated treatment sessions.

In contrast, marijuana addicts are people with a propensity for addiction who suffer a clearly delineated, verifiable, and vivid set of withdrawal symptoms when they try to quit. Armentano doesn't seem to have much interest in this cohort.

Armentano cites a study by the nonpartisan National Academy of Sciences Institute of Medicine--and then completely misses the point. According to the report, "[A]lthough [some] marijuana users develop dependence, they appear to be less likely to do so than users of other drugs (including alcohol and nicotine), and marijuana dependence appears to be less severe than dependence on other drugs."

What part of "some marijuana users develop dependence" does Armentano not understand?

The author appears to be making the common mistake of assuming that if pot causes withdrawal in some people, then it must cause withdrawal in everybody. And if it doesn't, it's not very addictive. This kind of thinking has been overtaken by the growing understanding that a minority of people suffer a chemical propensity for addiction that puts them at high risk, compared to casual, recreational drug users. The fact that most people don't get addicted to pot and don't suffer from withdrawal is no more revealing than the fact that a majority of drinkers do not become alcoholics.

The author further suggests that, since the Institute of Medicine report characterizes symptoms of weed withdrawal as "mild and subtle," there is nothing to this subject but hot air. Another way to think of "mild and subtle" is: not potentially life threatening, as in the case of abrupt withdrawal from alcohol. Pot doesn't kill. But we knew that already.

In addition, the author highlights the Institute of Medicine's estimate that "fewer than 10 percent of those who try cannabis ever meet the clinical criteria for a diagnosis of "drug dependence" (based on DSM-III-R criteria)." But this common estimate falls right in line with overall estimates placing the total addictive population for all drugs at between 10 and 15 per cent of the population.

Perhaps the most egregious error in the piece is the assertion that "pot's mild after-effects do not appear to be either severe or long-lasting enough to perpetuate marijuana use in individuals who have decided to quit." This statement is simply not true, as an overwhelming number of heavy pot smokers can attest. (For dozens of case histories that refute this contention, see the comments section of my post, Marijuana Withdrawal.)

The author also asserts that "the concept of pot addiction is big business," but it is unclear what he means by this, beyond his dismissive vote-of-no-confidence on anti-craving medications as an adjunct to addiction treatment.

I do, however, agree completely with Armentano on one point: None of this justifies "the continued arrest of more than 800,000 Americans annually" for pot violations.

Photo Credit: Javno

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