The Drug Myth That Will Not Die

Brits still pushing marijuana/schizophrenia connection.

If at first you don’t succeed....

The UK Telegraph reports that scientists at the Institute of Psychiatry in King's College London injected (yes, injected) 22 healthy men with high potency THC (not marijuana), and recorded the results. According to the leader of the study team, Dr. Paul Morrison, "These findings confirm that THC can induce a transient acute psychological reaction in psychiatrically well individuals."

The Telegraph article said the researchers found that the "extent of psychotic reaction" was not related to "the degree of anxiety or cognitive impairment" in the men.

Mary Brett, vice president of Europe Against Drugs, said: "This shows that anyone who is healthy can become psychotic by smoking cannabis. They don't already have to have a mental illness. Healthy people can become psychotic."

Well, no. Observant readers will no doubt find all of this familiar: More than a year ago, a national hysteria over “skunk” cannabis was sparked in Great Britain when the University College of London produced a study purporting to show that strong pot was literally driving people crazy. The lunacy peaked with Prime Minister Brown’s description of new strains of cannabis as 'lethal.' At the time, the London Guardian reported that "Whitehall's own panel of experts has concluded that increased marijuana use has not been matched by a corresponding rise in mental illness."

Against the advice of her own drug advisers, then-Home Secretary Jacqui Smith restored cannabis from class C to the “harder” class B status because of mental health concerns. British health authorities maintained that "skunk" cannabis was linked to the onset of schizophrenia. Since no one knows what, exactly, causes schizophrenia, and since recent findings continue to point toward genetic causes, this was a triply astonishing claim.

Colin Blakemore, a prominent professor of neuroscience at the Universities of Oxford and Warwick, tackled the issue of “pot so strong it can make you psychotic” in an article for the Guardian:

“And what of the alarming stories of horrifying powerful "skunk"? Some newspapers have told us that the level of THC, the active ingredient, in street cannabis today is 20 or 30 times higher than 10 years ago. That would be rather surprising, given that THC content was 7 per cent on average in 1995. In reality, two studies, due to be published later this year, concluded that the average THC content has doubled.”

With the latest report, King’s College has once again proven that if you inject someone with massive doses of THC, he or she will find the experience dramatically unpleasant. So do monkeys. Years ago, when researchers injected test monkeys with synthetic THC approximately one hundred times more powerful than the naturally occurring substance, the monkeys fell down and didn’t move. This was dramatic proof of... nothing in particular. But it was sensational and it made headlines.

Meanwhile, the solid fact that a minority of marijuana users experience strong withdrawal symptoms when they abstain—an important and verifiable scientific finding—remains largely unknown to the general public.


Photo Credit: http: www.healthjockey.com

addiction drugs

medical marijuana

The History of Prozac

How a pill for alcoholism became a blockbuster antidepressant.

Back in the 1970s, while doing research on antidepressants at Eli Lilly and Co., several organic chemists had been working on identifying new compounds that showed activity at serotonin receptor sites. The Lilly researchers came across Compound 82816, which very cleanly and very selectively blocked the reuptake of serotonin, and it did so without effecting any other neurotransmitter system at all. Clinical trials of compound 82816, chemically known as fluoxetine, continued into the early 1980s. At the same time, compounds with profiles similar to fluoxetine were being tested at various universities and drug firms.

The new drugs—with names like citalopram, zimelidine, fluoxetine, and fluvoxamine—were extensively investigated in animal models, and along the way, investigators made some unexpected discoveries. European investigators had shown that one serotonin uptake blocker in particular—zimelidine—seemed to reduce the self-administration of morphine and alcohol in addicted rats. A good part of the research began to center on three serotonin-enhancing compounds—zimelidine, citalopram, and fluoxetine.

Since rats decreased their administration of both alcohol and morphine when given zimelidine, and since low serotonin is a strong potential marker for human alcoholics and other addicts, Dr. Claudio Naranjo and Dr. Ed Sellers, along with their colleagues at Toronto’s Addiction Research Foundation, began testing zimelidine on heavy drinkers. Characterized as “early stage problem drinkers,” the test subjects showed a slight but noticeable decrease in the number of drinks consumed per day when they took zimelidine. There was also a consistent increase in the number of days the drinkers were completely abstinent. (Zimelidine was later withdrawn from use worldwide because of immune system side effects.)

As research continued, it became consistently evident that drugs capable of increasing concentrations of brain serotonin tended to cause large numbers of animals and human test subjects to drink less alcohol. But it wasn’t simply an aversive reaction at work, as in the case of Antabuse. People in the clinical trials still drank, but in many cases, the urge to drink seemed to diminish, and while the decrease was modest, it was measurable.

Moreover, rats given serotonin-enhancing drugs selectively cut back on carbohydrates, and lost weight. Ultimately, Lilly’s investment centered on flouxetine. In late 1987, Fortune magazine’s article on fluoxetine reported that “the prospect of making people both happy and thin has helped Lilly stock rise 28 per cent this year.”

The prospect of making alcoholics drink less, or stop drinking altogether, was a less publicized but equally attractive notion. Lilly already had a trade name picked out for fluoxetine. They were calling it Prozac.

A year after its introduction as an antidepressant, Prozac was a runaway success. Prozac quickly proved the existence of a huge potential market for serotonin reuptake inhibitors. Research continued on the diminished craving response that the serotonin uptake blockers seemed to produce in certain drinkers. The drug’s allure as an anti-craving medication for alcoholism and other possible addictions remained an open secret among researchers. Lilly wasn’t saying much in public about it, and with sales booming for fluoxetine as an antidepressant, the company could afford to concentrate on that indication. In the end, Lilly chose not to pursue further investigation of Prozac’s ability to reduce drinking and initiate weight loss.

Excerpted from The Chemical Carousel: What Science Tells Us About Beating Addiction by Dirk Hanson © 2008

Photo Credit: http://bryanking.net/prozac-fluoxetine

addiction drugs

The Changing Face of Addiction Counseling

Most addiction workers are no longer addicts themselves.

For years, addiction therapists and counselors tended to be people who had been addicts themselves. These days, not so much. Drug and alcohol counselors who have experienced addiction firsthand represent a dwindling slice of the addiction therapy community.

But does it matter? A recent study by William L. White for the Great Lakes Addiction Technology Transfer Center and the Philadelphia Department of Behavioral Health and Mental Retardation Services suggests strongly that it does not. The study, “Peer-based Addiction Recovery Support” (PDF), concluded that “Studies of addiction counselors in the United States have not found that addiction counselors in recovery are more or less effective than addiction counselors who are not in recovery....”

This is a good thing, if true, since the report also documents that the percentage of counselors in personal recovery within the “addiction workforce” has fallen from a high of almost 70 % in the early 1970s to about 30% as of 2008. It is unclear what is behind this trend, given that “studies of the personalities of recovering men and women working as addiction counselors reveal few differences from counselors without addiction recovery backgrounds.” White suggests that as the “educational levels of people in recovery have increased,” the perceived differences between counselors in recovery and those not in recovery “diminish or disappear completely.”

The bottom line for counselors: “The key determinants of effectiveness do not include recovery status.”

Nonetheless, White argues, attitudes toward workers in addiction treatment continued to be “plagued by misconceptions and stereotypes that are contradicted by most scientific studies. The prevailing view is that the majority of addiction counselors are in recovery; that most recovering counselors do not have college or advanced degrees; and that recovering counselors differ in their attitudes beliefs, knowledge, skills, and effectiveness” from counselors who have never experienced addiction.

Nowadays, as it turns out, none of these views is correct.

White’s paper also reiterated the sad fact that recovering addicts who work in addiction treatment “are paid less than people not in recovery for comparable work, even when their educational credentials are equal.”


Photo Credit: US No Drugs

addiction drugs

Friday File

Book and Blog Recommendations

Books

Garrison Keillor, my state’s answer to Mark Twain, often used a signature phrase on his radio show: “Be well, do good work, and keep in touch.” Michael S. Gazzaniga, brain scientist extraordinaire, says that this simple statement explains the essential difference between the cognitive complexity of humans and that of other primates. Put simply, “Other apes don’t have that sentiment.”

A cognitive neuroscientist at the University of California–Santa Barbara, Gazzaniga’s recent book, Human: The Science Behind What Makes Us Unique, looks at how we diverged from our ancestors to become sentient human beings. Hint: It has less to do with tool use and opposable thumbs than you might expect.

Gazzaniga wears his learning lightly and puts forth his ideas in an easy-going style. Though he does not mention them by name, he could have been thinking about PETA when he poses the ultimate question: “Would a chimp make a good date?”

Blogs

Neuroanthropology, a site dedicated to the “greater understanding of the encultured brain and body,” is another interdisciplinary gem of a blog.

In their own words, Neuroanthropology is a “collaborative weblog created to encourage exchanges among anthropology, philosophy, social theory, and the brain sciences. We especially hope to explore the implications of new findings in the neurosciences for our understanding of culture, human development, and behaviour.”

As part of that eclectic mix, Daniel Lende keeps a keen eye on the biology of drugs and alcohol, with a particular emphasis on “biopsychosocial” approaches to addiction.

Some of Neuroanthropology’s more popular posts include “Cultural Aspects of Post-Traumatic Stress Disorder,” “Sarah Palin and Language,” “Studying Sin,” and “How Your Brain is Not Like a Computer.” The site also features a great page of Web Resources.

Addiction Science and the Problem of Perception

Why don’t mental health professionals get it?

Dr. Joanna Moncrieff, identified by the BBC News as a “mental health expert,” gave the world the benefit of her view on the use of drugs for mental disorders in a July 15 article titled “The Myth of the Chemical Cure.”

Joanna Moncreiff’s version goes like this:

“If you've seen a doctor about emotional problems some time over the past 20 years, you may have been told that you had a chemical imbalance, and that you needed tablets to correct it. “

True.

“Magazines, newspapers, patients' organisations and internet sites have all publicised the idea that conditions like depression, anxiety, schizophrenia and bipolar disorder can be treated by drugs that help to rectify an underlying brain problem.”

True.

“People with schizophrenia and other conditions are frequently told that they need to take psychiatric medication for the rest of their lives to stabilise their brain chemicals, just like a diabetic needs to take insulin. The trouble is there is little justification for this view of psychiatric drugs.”

Deeply, undeniably false.

“First, although ideas like the serotonin theory of depression have been widely publicised, scientific research has not detected any reliable abnormalities of the serotonin system in people who are depressed.”

False—but a new and increasingly popular line of attack. None of the major findings about the relationship between serotonin metabolism and clinical unipolar depression has been overturned. The Serotonin hypothesis of unipolar depression is still a fundamentally sound and useful model, as evidence by the stunning success of serotonin-boosting antidepressants.

But wait! The success of SSRIs is proof that serotonin has nothing to do with it! Moncrieff writes: “It is frequently overlooked that drugs used in psychiatry are psychoactive drugs, like alcohol and cannabis. Psychoactive drugs make people feel different; they put people into an altered mental and physical state. They affect everyone, regardless of whether they have a mental disorder or not.”

False—all three statements. A trifecta of untruths. Psychoactive drugs for mental illness are not necessarily chemically akin to alcohol and cannabis, many of the drugs do not “make people feel different” or vault them into an altered mental state, and the drugs do not effect most “normal” people who do not have one of the underlying mental disorders the drugs are designed to treat.

“In my view it remains more plausible that they ‘work’ by producing drug-induced states which suppress or mask emotional problems.’

False—and happily, her view on the matter is not shared by many reputable neurologists. The quotation marks around the word “work” would seem to tell us all we need to know about Ms. Moncrieff’s relationship to modern medicine.

“At the moment people are being encouraged to believe that taking a pill will make them feel better by reversing some defective brain process.”

True--and we should thank our lucky stars that we have progressed out of the dark ages when it comes to the treatment of mental illness.

“If, on the other hand, we gave people a clearer picture, drug treatment might not always be so appealing.”

True—but on another hand, uncounted numbers of addicted people might find the prospect very appealing, if only they could afford it, or were under the care of a health professional who understood what the medication could do for her patients.

Graphics Credit: 1800blogger


addiction drugs

Stimulating Facts About Caffeine

Coffee highs and lows.

[Excerpted from “Caffeine: Pharmacology and Effects of the World’s Most Popular Drug,” by Kyle M. Clayton and Paula Lundberg-Love, in The Praeger International Collection on Addictions Volume 2]:

-- Caffeine dependence is not presently recognized as a clinical disorder in the American Psychological Association’s DSM-IV-TR. Caffeine intoxication, however, is listed as a distinct clinical syndrome. Most of the symptoms of caffeine intoxication resemble symptoms of cocaine or amphetamine overdose: anxiety, insomnia, restlessness, tremor, irritability, rambling speech patterns, and irregular heartbeat. “In adult cases of highly elevated doses,” the authors write, “symptoms such as fever, hallucinations, delusions and loss of consciousness have occurred.”

--In high enough doses, caffeine is extremely toxic and can lead to death. The good news: This almost never happens, since the potentially lethal dose is on the order of 50 to 100 cups of coffee, quickly consumed. There is, however, the theoretical risk that an overdose of caffeine tablets could be fatal.

--Caffeine tolerance develops in a hurry. Tolerance to the sleep-disrupting effects of coffee in high doses can occur after only seven days of consuming 400 mg of caffeine three times a day—using 120 mg per cup as a rough average, that amounts to about ten cups of strong coffee per day. The researchers report that “complete tolerance to subjective effects such as nervousness, tension, jitters and elevated energy were observed to develop after consuming 300 mg three times per day for 18 days, and it is possible that such tolerance can occur within a shorter period of time.”

--Caffeine can interfere with the effectiveness of benzodiazepines and other medications that act on the neurotransmitter GABA. “Caffeine can inhibit the binding of benzodiazepines to their specific receptors on the GABA-A receptor sites, therefore neutralizing the effects of such medications and inhibiting their sedative hypnotic effects. Such interactions should be considered when evaluating the effectiveness of medications used to treat insomnia.”

--Conversely, caffeine can enhance the effectiveness of pain relievers. In particular, caffeine allows for faster absorption of headache medications, producing faster relieve at lower doses. Nicotine increases the rate at which the body metabolizes caffeine. Abstinent cigarette smokers often discover that their usual intake of coffee causes jitters and a bad stomach once they quit smoking. Some researchers have speculated that a high level of caffeine intake during smoking cessation might cause an increase in nicotine withdrawal symptoms.

Photo Credit: www.healingwithnutrion.com

addiction drugs

Harm Reduction Scorecard

A look at drug strategies worldwide.

A fascinating study released earlier this year by the International Harm Reduction Association (IHRA) provides a snapshot of the staggering country-by-country variations in drug law and policy across the globe.

While Western Europe and North America have in place a solid base of operational heroin substitution therapies, such as methadone, these same Western countries have fallen behind in prison addiction programs, including all-important needle exchanges.

Countries lacking widespread access to heroin substitution programs include Russia, Afghanistan, Pakistan, Cambodia, and most of Latin America with the exception of Mexico. These are also, coincidentally or not, all regions of substantial opium cultivation.

As it turns out, every major nation except South Africa—where the ravages of HIV are all too evident--has put in place needle and syringe exchange programs of one scope or another, in at least one location in the country.

Interestingly, the IHRA report, titled “Harm Reduction Policy and Practice Wordwide,” finds that some of the countries with the most active needle exchange programs in prisons include Armenia, Kyrgyzstan, Romania—and Iran, which also offers heroin substitution therapy in prisons. Notable countries lacking widespread needle exchange programs in prisons include the United States, Latin America, and portions of Western Europe.

Finally, regarding the most radical category in the harm reduction arsenal—drug consumption rooms, also known as safe injection facilities—the world has been significantly slower to adopt this approach to the public consumption of injectable drugs. The document lists the existence of drug consumption rooms in Canada, Australia, Germany, Norway, the Netherlands, Spain, and Switzerland.

The report, prepared by Catherine Cook, a Research Analyst with IHRA, notes that the listings do not indicated “the scope, quality or coverage of services.” And while almost all countries have national policy documents that make reference to harm reduction policies for health or drug-related policy, strategies vary widely.

“Of particular interest here is the US,” the report notes, “which includes harm reduction in its national HIV and hepatitis C strategy documents, but not in those relating to drug policy.”


Graphic Credit: Bristol Drugs Project


addiction drugs