If You’ve Seen One Drug Czar....

The language of drug politics.

In a May 29 post on his Salon blog, Drug WarRant, Peter Guither deftly deconstructs the language of drug czarism, and its corrosive effect on rational dialog over drug policy:

--So far, there has been little or no discussion of marijuana from the newest drug czar, Obama’s man Gil Kerlikowske, now director of the White House Office of National Drug Control Policy. “I've got to admit that it's a nice change from the reefer madness reign of Walters,” Guither writes. “Maybe Kerlikowske is following my mother's age-old advice... If you can't say something nice (and he can't by law), then don't say anything at all.”

--Prescription drugs are “the new crack.” To his credit, Guither worries about this new emphasis, and where it is likely to lead: “The prescription drug "epidemic" will be an excuse to further crack down on diversion, which will end up continuing the focus on pain doctors who prescribe large amounts of pain medication, with DEA agents deciding they know more than doctors. The result will be even more people suffering, unable to get the pain medication that actually makes life possible for thousands of people.”

--Drugs cause crime. As proof, Kerlikowske cites the statistic that half the men arrested in ten major U.S. cities tested positive for some sort of illegal drug, as reported by USA Today. From this data, Kerlikowske concludes that there is “a clear link between drugs and crime.” Guither notes that “There's a lot of reasons that people who have been arrested would tend to test positive for illicit drug use than the general population..... A very large percentage of arrests are for drug crimes, which naturally skews the population. Then there are socio-economic factors and a lot more.”

However, what the new drug czar is implying, writes Guither, is that drugs cause crime. “But implying that drugs cause crime is a lie. And that's what drug czars do.”

Kerlikowske has also come out in favor of greater use of drug courts as an alternative to prison sentences. Bill Piper, director of national affairs for the Drug Policy Alliance Network, told USA Today he agreed that drug use should be seen as a public health issue, but that “people shouldn't have to get arrested to get treatment."

Photo Credit: Lifehype Magazine

addiction drugs medical marijuana

Cocaine Treatment Drug Flunks the Test

Vigabatrin fails in clinical trials.

It wasn’t the Last Best Hope, or the Holy Grail, but it had stirred up great excitement as possibly the first effective treatment medication for cocaine addicts. So it was nobody’s idea of happy corporate news when Catalyst Pharmaceutical Partners of Coral Gables, Florida, announced last Friday that its drug Vigabatrin, known as CPP-109, had failed as a cocaine treatment in Phase II clinical trials.

Brian Bandell of the South Florida Business Journal reported that during the 12-week study, the drug did not help drug addicts stay cocaine-free, compared to a placebo group.

In a press release, CEO Patrick McEnany said “we are not ready to abandon our view that CPP-109 has the potential for use in treating cocaine addiction, which still represents a significant unmet medical need.” Vigabatrin is sold overseas as Sabril by a Belgian company, but is not approved for use in the United States. Earlier animal testing and two limited early-stage studies on human addicts in the 2003-2004 had convinced the company that Sabril diminishes cravings for stimulants. It may also blunt the euphoric effect of meth and cocaine.

Catalyst’s stock, traded on NASDAQ, fell 57 percent to 90 cents a share on the news. The company started operations in 2006. According to the Miami Herald, Catalyst raised $21 million in its initial public offering on a single drug “with huge potential.” McEnany told the Herald he was uncertain why the drug had failed, but added that “cocaine addicts are a very unpredictable group.” He said the company would be analyzing the data over the next few months. “The data is immense. We’re trying to get our arms around it.”

Ovation Pharmaceuticals (now Lundbeck, Inc.), which hopes to market the drug under the trade name Sabril in the U.S., had also promised to push forward with clinical trials.

Edward H. Nash of Merriman Curhan Ford, a San Francisco financial research firm, downgraded Catalyst’s stock on Friday. “Unfortunately, we do not believe Catalyst has the opportunity and the right technology in hand,” he said, adding that the firm “no longer represents a viable biotech investment.”

Vigabatrin attracted initial interest because of its ability to dampen neuronal responses to excess amounts of dopamine produced by chronic cocaine use. As noted earlier (FDA Puts Coke/Meth Treatment on Fast Track), the U.S. Food and Drug Administration (FDA) had given “Fast Track” designation to vigabatrin, an anticonvulsant, for evaluation as an anti-craving drug for cocaine and methamphetamine addiction.

However, potential side effects threatened to derail the trials almost before they started. The FDA was already on record with its concern about reports of retinal damage in patients overseas. (See “Drug For Cocaine Addicts Causes Weight Loss”).

Graphic Credit: Addiction Treatment Forum

addiction drugs dopamine

Study Probes Military’s “Culture of Binge and Underage Drinking”

Problems continue after active duty.

A University of Minnesota study found a level of underage binge drinking in the military that the study’s lead author called “dangerous to both the drinkers and those around them.” Mandy Stahre, the epidemiologist who headed up the study, said the results were disturbing, “given the equipment and dangerous environments commonly encountered by active duty military personnel.”

The article, “Binge Drinking Among U.S. Active-Duty Military Personnel,” appears in the March issue of The American Journal of Preventative Medicine. Researchers at the University of Minnesota and the Centers for Disease Control analyzed the results of an anonymous health survey of 16,000 military personnel conducted in 2005. (The group defined binge drinking as four or more drinks in one session for men, and three or more drinks for women.) In an interview with a University of Minnesota radio station, Stahre said that 43 percent of the active respondents reported binge drinking in the past month. Stahre said the figure represents “a total of 30 million episodes of binge drinking, or 32 episodes of binge drinking per person per year.” 5 million of those episodes, Stahre said, involved active duty personnel under the age of 21.

These figures are scarcely surprising, but the implications are no less nerve-wracking. Stahre said military binge drinkers were five times more likely to drive while drinking, compared to non-binge drinkers. Moreover, binge drinking is chronically under-reported in the military, Stahre said, cautioning that the conclusions in the study “may be conservative.” She called for an increase in alcohol excise taxes, stricter military enforcement of a minimum drinking age of 21, and “greater efforts at screening and counseling for alcohol misuse” in the military.

What can a study of this nature accomplish? Stahre said she hopes it will provide “further evidence that binge drinking is a major public health problem in the U.S. and in the military. And the military may be in a unique position to help reduce this problem in the general population, particularly given that nearly 13 percent of U.S. adults report current or past military service.”

Last summer, a study published in the August 13 issue of the Journal of the American Medical Association (JAMA) demonstrated that Reserve and National Guard combat personnel returning from the wars in Iraq and Afghanistan were at increased risk for “new-onset heavy drinking, binge drinking and other alcohol-related problems.” The article also found a strong association between posttraumatic stress disorder (PTSE) and substance abuse among returning veterans.

photo credit: http://navyformoms.ning.com/

addiction drugs

Marijuana Legalization Is Coming, Says Pollster

Nate Silver reads the numbers.

Last month, I missed this crucial article, penned by the inestimable Nate Silver. Silver, you may recall, is the numbers nerd who shamed all conventional pollsters during the run-up to the presidential election—and then proceeded to predict the Electoral College vote with perfect accuracy.

So when Nate Silver takes a hard look at statistics having to do with American sentiment about marijuana legalization, it behooves us to take his findings seriously. In an April 5 post called “Why Marijuana Legalization is Gaining Momentum,” on his FiveThirtyEight.com blog, Silver lays out the inevitable chronology.

“Back in February, we detailed how record numbers of Americans -- although certainly not yet a majority -- support the idea of legalizing marijuana,” Silver writes. “It turns out that there may be a simple explanation for this: an ever-increasing fraction of Americans have used pot at some point in their lifetimes.”

According to Silver’s number crunching, the peak pot year in anyone’s life is on or about age 20—duh—with most people reaching some sort of usage plateau between the ages of 30 and 50. The important point, Silver writes, has to do with the fraction of adults who have used. This is a dual-peaked distribution, “with one peak occurring among adults who are roughly age 50 now, and would have come of age in the 1970s, and another among adults in their early 20s. Generation X, meanwhile, in spite of its reputation for slackertude, were somewhat less eager consumers of pot than the generations either immediately preceding or proceeding them.”

Furthermore, reports of lifetime usage drop off precipitously after 55. “About half of 55-year-olds have used marijuana at some point in their lives, but only about 20 percent of 65-year-olds have.”

What does this tell us? While there is certainly not an exact correspondence between people who have smoked pot and people who support legalization, Silver ventures to guess that the link is fairly strong. What we have here, he argues, is a “fairly strong generation gap when it comes to pot legalization. As members of the Silent Generation are replaced in the electorate by younger voters, who are more likely to have either smoked marijuana themselves or been around those that have, support for legalization is likely to continue to gain momentum.”

Photo: Minnesotaindependent.com

addiction drugs medical marijuana

Addiction Assumptions: The Meth Epidemic

Who is really at risk?

A simple question: Has meth use in the United States truly reached “epidemic” levels, as is commonly stated by health authorities and drug experts?

The answer depends on how you slice the data, according to sociologist Herbert Covey. For women, unemployed men, and residents of the Western United States, the answer is yes. For African-Americans and citizens of the Northeast, not so much.

In “Prevalence of Use and Manufacture of Methamphetamine in the United States,” published in the Praeger International Collection on Addictions, Dr. Covey first notes that the spread of methamphetamine use is by no means unique to the United States. In Thailand, Covey writes, more than 70 percent of the addict population is composed of meth users.

In the U.S., meth lab busts increased 4,000 percent from 1995 to 2001, according to the Office of National Drug Control Policy. Treatment numbers also soared, but it is not clear whether this trend represents more meth users, or more court-mandated treatment for offenders.

The short answer to the question of who is at primary risk is: women. According to Covey, women of childbearing age represent a severely problematic risk group. Women report using meth at an earlier age, have significantly longer first treatment experiences, and have greater difficulty than men with related issues of employment, child-raising, and job opportunities. (See my post on “Rehab and the Working Mother.”)

Perhaps the most unwelcome finding of all is that “The majority of women [in a major study of gender differences] had children under 18, but most did not live with their children within the last 30 days.”

However, there is a tendency in the media to leap ahead of the data with stories of this sort. Covey and other researchers question the validity of media references to “meth babies” and “ice babies,” recalling the overblown coverage of the “crack baby” epidemic of the 1980s—an epidemic for which, more than two decades later, there is almost no solid evidence. As Covey cautions, “that meth use by pregnant women results in severe health consequences for infants has not been established by medical research.”

As Covey sums it up: “Meth accounts for a small percentage of the total number of people affected by drug and alcohol problems. However, almost all of the data... reveal that meth use, manufacturing and distribution are increasing throughout much of the nation.” In the future, he writes, “The other question is whether meth use will grow in prevalence in minority populations. To date Latino, Hispanic, and African American populations have not embraced meth to the extent that Anglos have. If this changes, the negative effects could be substantial.”

Covey concludes: “Whether the upward spiral of meth use and manufacture continues remains to be seen.”

Photo Credit: The Curvature

addiction drugs

Addiction Assumptions: Denial

Is denial always part of the deal?

Maybe denial really IS just a river in Egypt. Lorraine T. Midanik, dean of the School of Social Welfare at the University of California in Berkeley, is convinced that the contemporary concept of denial as applied to alcoholism represents a weak link in the disease model of addiction.

Neither the founding fathers of Alcoholics Anonymous, nor the foremost early proponent of the disease model—E.M. Jellinek—specifically identified denial as a core concept of alcoholism, according to Midanik. In “The Philosophy of Denial in Alcohol Studies: Implications for Research,” which appears as a chapter in The Praeger International Collection on Addictions, Midanik highlights the conclusion that often results from making a strict association between alcoholism and denial: “There is no room in this perspective for truth telling from the drinker himself.”

The more often and the more energetically a drinker protests against the hypothesis that he is drinking alcoholically, the more telling the proof that the drinker is “in denial” and therefore incapable of rational decision-making about drinking. Clearly, this is exactly the case in many instances. Denial exists. However, Midanik argues that “the definition of denial in alcohol studies has been expanded well beyond its original meaning” to include a host of vaguely Freudian defense mechanisms, including hostility and other forms of negative behavior. Midanik, who is openly skeptical regarding many aspects of the disease model, complains that denial has been broadened into a catchall category “for any behavior that prevents the adoption of the disease model system.”

As the “disease model system” is often presented to patients in various rehab centers around the country, I would tend to agree. But Midanik also questions whether there really exists anything beyond what she labels “tactical denial,” meaning “deceptive maneuvers used by alcoholics to conceal the extent of their drinking.” In such cases, the drinker is obviously aware of what he or she is doing, so the more appropriate term might be “lying.” Nonetheless, I firmly believe that denial, in the sense of lack of self-awareness, or dissociation, is often an acute part of the presenting symptoms of alcoholism, if not quite the “central core of alcoholism treatment,” as Midanik sees it.

Midanik describes something like a cabal of interests helping to foster and inflate the denial concept—AA, Al-Anon, and various codependency groups in particular—even though “study after study and review after review report that alcoholics give valid self-reports....” Here Midanik is onto something interesting. As she intriguingly relates, the near-universal presumption guiding “interventions” or “structured encounters” with supposed alcoholics is that “there is a continuum with denial on one end and truth telling on the other. Overreporting rarely if ever exists.”

Yet overreporting is a well-known issue in clinical research. Midanik refers to the “hello-goodbye effect,” in which patients tend to overemphasize their symptoms when entering treatment, and to minimize them at the end of treatment. If new patients overreport their alcohol consumption, “there are important implications for treatment personnel who base treatment decisions on these self-reports.” Moreover, overreporting may also bias clinical studies “by inflating success rates (presuming there was an opposite bias after treatment). Yet despite the implications of these findings, little interest has been shown by researchers in the alcohol field to explore this area.”

Photo Credit: shatteringdenial.com

addiction drugs alcoholics anonymous

The Alcoholic Rats of Dr. Li.

Excerpt from chapter 1 of The Chemical Carousel.

In the early 1990s, it was safe to say that Dr. Ting-Kai Li was in possession of the largest and most famous collection of alcoholic rats in the world.

Housed in a laboratory near Dr. Li’s office at Indiana University, the “P-line” of rodents were freely self-administering the body-weight equivalent of one bottle of whiskey a day for a 155-pound man; a blood alcohol concentration that would have gotten them arrested on any highway in America. The P-line rats were seriously addicted to ethanol, the purified form of booze known outside the laboratory as grain alcohol, or white lightning.

“It’s actually the only line that’s been well developed in the world,” Dr. Li told me at the time, with justifiable pride. “And it has been developed through genetic selection for alcohol preference.” In other words, Dr. Li did not teach these animals to drink. He didn’t have to.

Dr. Li, who was until recently the Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which is the alcoholism wing of the National Institutes of Health (NIH), made it sound easy: “You take a stock with some genetic heterogeneity in it, and then you test it for drinking behavior, and there will be, say, two or three out of a hundred that like to drink, so you take those, and you breed them. And the ones that don’t like to drink, you breed those, and within ten generations you start to have a very good separation between drinking scores.”

Why would a rat drink alcohol, and why would anybody care? When I first spoke with Ting-Kai Li, the lack of suitable animal models of alcoholism and addiction was all too apparent. Without suitable strains of test animals, most genetic and neurobiological research would take centuries, and would involve ethical questions about human testing far stickier than the questions raised by the animal rights movement. Animal models are one of the primary pathways of discovery available to neurobiologists and other researchers.

The precisely spoken, self-effacing Dr. Li, along with neurobiology professor Dr. William McBride and their co-workers at Indiana University, were never really in the business of teaching rats to drink. They were in the business of discovering ways to make them stop.

To be like human alcoholics, the rats must also demonstrate both an increased tolerance to the effects of the drug, and the onset of physical dependence as manifested by withdrawal symptoms. And they do. The P-line rats develop tolerance, and they show acute withdrawal symptoms when researchers cut off their supply. The rats suffer tremors, seizures, and a rodent version of delirium tremens. They fall down a lot. They are also quick to avail themselves of a little “hair of the dog.” After a period of abstinence, they take alcohol again to relieve the withdrawal symptoms.

The P-line rats met every definition of alcoholism anyone could imagine, and the cause of their alcohol addiction appears to be strictly genetic. What was happening with the P-line rats was not explainable by resorting to arguments about simple learned behavior.

“How do you explain this difference?” said Dr. Li, all those years ago. “My explanation is that there are genetic differences among different individuals. You’re making the assumption that you expose them to the same environment, the same environmental influences, and yet they behave differently in terms of addiction.”

Today, we can safely say that Dr. Li’s hypothesis has proven to be true.

© Copyright 2008

Photo Credit: smh.com.au

addiction drugs