Cannabis for Multiple Sclerosis

Nasal spray to be approved in Europe.

A cannabis-based nasal spray will receive approval later this month for marketing in the United Kingdom and Spain as a medicine for multiple sclerosis, makers of the compound announced this week.

GW Pharmaceuticals, makers of Sativex, won earlier regulatory approval for the use of Sativex in Canada in 2005. Users spray the cannabis mist under their tongues for the relief of spasticity due to M.S. It is intended primarily as an “add-on treatment for symptom improvement,” according to The Pharma Letter, in patients “who have not responded adequately to other anti-spasticity medication.”

The London Evening Standard reported that the company, which grows its marijuana in undisclosed locations in England, expects the treatment to be offered as early as June under marketing agreements with Bayer of Germany and Almirall of Spain. A Japanese pharmaceutical firm has marketing rights to Sativex in the U.S., but the drug has not garnered any significant attention or approval here.  The Evening Standard reported that marketing rights from Bayer and Almirall could add up to more than $20 million when the medicine is formally approved.

European regulatory officials stress that they still have to finalize local wording on product packaging and associated documents before final marketing approval can be granted.

GW Pharmaceuticals has been working on Sativex for more than a decade now, as a medication for  multiple sclerosis patients, as well as patients suffering from advanced cancers. Chairman Geoffrey Guy said that the company was “transitioning from a late-stage development company to a commercial pharmaceutical business with excellent growth prospects.”

Photo Credit:  http://www.medicinskmarijuana.com

Al Hubbard, the Johnny Appleseed of LSD

“The Original Capt. Trips.”

The scientists, therapists, and artists who experimented with LSD therapy in the late 1950s were not prepared for the likes of Timothy Leary, novelist Ken Kesey, poet Allen Ginsberg, and the assorted freaks, pranksters, con artists and runaways of the Woodstock Generation. Ken Kesey, in particular, delighted in stinging the Feds by insisting that it was Uncle Sam who first got him high, paying Kesey and others to take LSD, guinea pig-style, in certain government-funded research programs in Palo Alto and at Stanford University in the early 1960s.

It made a great story, and it happened to be true. However, the original chapter of the acid story began ten years earlier, when a former intelligence agent, rogue businessman, and general intellectual gadfly named Al Hubbard took his first LSD trip. Captain Alfred M. Hubbard, who has been dubbed the “Original Capt. Trips,” was part of a select cadre of World War II veterans who had been involved in creating intelligence institutions like the Office of Strategic Services and the CIA, and who had immersed themselves in cryptology and truth serums and interrogation drugs in the service of the war effort. (Thomas Pynchon caricatured some of this work in his novel, Gravity’s Rainbow.) Hubbard broke ranks with the intelligence community early on, but continued to share his clandestine stash of LSD with certain friends and acquaintances. This odd and extraordinary businessman is said to have arranged private LSD sessions in the late 1950s for scientists, captains of industry, members of the British parliament, UN representatives, prime ministers, and various artists. For a time, Al Hubbard settled in Vancouver, where he became Canada’s only legally licensed, FDA-approved importer of Sandoz LSD. In certain North American research circles, Al became a very popular man.

Hubbard is credited by various parties with being the man who put together the basics of the North American psychedelic therapy sessions and hippie acid tests to come—high doses of LSD, amplified music, strobe lights, and experiments with ESP. Along with Huxley, Hubbard came to believe that the more mystical or “transpersonal” experiences LSD sometimes afforded might hold considerable psychotherapeutic potential. With LSD provided by Hubbard, Canadians Abram Hoffer, Ross Mclean, and Humphrey Osmond pursued the idea of LSD as a treatment for alcoholism. In the U.S, research on LSD and alcoholism was undertaken by Oscar Janiger, Sanford Unger, and others on the West Coast.

Throughout this period, there were LSD clinics operating in England and Europe. European LSD therapists tended to use very low doses as an adjunct to traditional psychoanalytic techniques. But North American researchers took a different, bolder approach. When “psychedelic” therapy began to catch on in Canada and the United States, therapists typically gave patients only one or two sessions at very high doses. These early efforts were aimed at producing spontaneous breakthroughs or recoveries in alcoholics through some manner of religious epiphany or inner conversion experience. The only other quasi-medical approach of the day, the Schick Treatment Center’s brand of “aversion therapy,” was not seen to produce very compelling long-term recovery rates, and subsequently fell out of favor.

In this light, the early successes with LSD therapy, sometimes claimed to be in the 50-75 per cent range, looked noteworthy indeed. However, the design and criteria of the LSD/alcoholism studies varied so widely that it has never been possible to draw definitive conclusions about the work that was done, except to say that LSD therapy seemed to be strikingly effective for certain alcoholics. Some patients were claiming that two or three trips on LSD were worth years of conventional psychotherapy—a claim not heard again until the advent of Prozac thirty years later.

Adapted from The Chemical Carousel: What Science Tells Us About Beating Addiction by Dirk Hanson © 2008, 2009.

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Feel Lucky, Drunk?

Sobering stats on alcohol-impaired driving.

Somewhere just before the stages veteran drinkers sometimes refer to as “bulletproof” and “invisible” comes a stage known as, “Can I drive home drunk, and avoid arrest?”

In the small town where I live, the college kids have it lucky: They can park their cars at the afterparty, and walk, or rather weave, to their respective domiciles, leaving a trail of frustrated cops parked in squad cars, waiting for fresh meat to slide drunkenly behind the wheel.  Not much point in breathalyzing pedestrians. 

Summer is approaching, and with it, new opportunities for drunk driving. Your chances of safely driving home drunk, without arrest, are 49 out of 50, according to figures from the AAA Foundation for Public Safety. Roughly 1 in 50 drunk drivers gets arrested while driving. However, considering the stiff penalties associated with DUI and DWI-type offenses, are those odds really good enough to take the risk?

Consider a few additional numbers from the Centers for Disease Control and Prevention (CDC): The annual cost of drunk-driving crashes is somewhere in the neighborhood of $51 billion. Every day, 32 people in the United States die in crashes that involve an alcohol-impaired driver.  This results in a truly appalling number: 1 in 45, or 1 death due to drunk driving every 45 minutes--all day, every day.  Almost one-third of all traffic-related deaths in the U.S. each year. That is the true cost, the daily dice throws, caused by being drunk behind the wheel.

But there is another set of equally appalling numbers, relating to that 1 in 50 figure we started with. In 2008, over 1.4 million drivers were arrested for driving under the influence of alcohol or narcotics--less than one percent of the 159 million self-reported episodes of alcohol-impaired driving among U.S. adults each year. The CDC estimates that 2.5 million parents drive under the influence of alcohol each year. Drunk drivers involved in fatal crashes were eight times more likely to have a prior conviction for DWI than were drivers with no alcohol.

Oh yes, and here is another number you should remember: 0.08 per cent.  That is the blood-alcohol content limit in all 50 states, at this writing.  According to the CDC, fatal alcohol-related crashes have dropped by 7 per cent since the adoption of the 0.08 standard.

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

Cocaine Treatment and the Stroop Test

Treatment dropouts do poorly on color/word match.

It’s commonly used to demonstrate behavioral inhibition, but it’s also a nifty parlor game. It is called the Stroop Test, and it plays off the fact that people are far better at reading words than they are at intentionally ignoring them. To prove it, John Ridley Stroop’s 1935 Ph.D. thesis showed how difficult it is to interfere with the automatic processing of words. In the basic Stroop test, a list of color names is presented. However, the word green might be printed in red ink, and the word red might be printed in blue ink. The task is to quickly name not the word itself, but the color of the word. As an example, for the word “green” printed in red ink, the correct verbal answer is “red.” Because of a phenomenon called directed attention, this is hilariously difficult to do. The subject must actively inhibit the automatic response—reading the word—in order to do something else.

What’s all this got to do with drug addiction?

Psychologists have known for some time that drug craving focuses attention on drug-related stimuli in the environment, and draws attention away from environmental cues unrelated to drugs. Naturally, researchers began to wonder whether the Stroop test could be brought to bear on the matter of addiction, and employed as a tool with which to predict the likelihood of relapse among the addict population. 

As researchers at the University of Wales have pointed out,  “Decisions about drinking and drug use can be highly automatic, with users being unaware of the factors that influence their decisions.” At the same time, addicts are hyper-aware of addiction-related environmental stimuli, compared to non-addicts. As a result, “the automatic processing of addiction-related stimuli might elicit conditioned responses such as withdrawal… or they might invoke automatic patterns leading to substance use.”

In a recent study of treatment dropouts among 74 cocaine-addicted subjects, published in Neuropsychopharmacology, Dr. Chris Streeter and coworkers at the Boston University School of Medicine and Harvard University provide strong evidence for the use of the Stroop Test as a diagnostic tool in addiction treatment.  Variations on the Stroop Test were better predictors of dropout than addiction severity, depression, and other clinical variables.  Dropouts took 24 per cent longer, on average, to finish the tests than cocaine addicts who stuck with treatment, the researchers reported.  “These finding suggest that the Stroop test can be used to identify cocaine-dependent subjects at risk for treatment dropout,” say the researchers, and that it can serve as another instrument with which to “identify and tailor interventions of at risk individuals in the hope of improving treatment compliance.”

Furthermore, other studies suggest that attentional bias may serve as a useful predictor of opiate relapse and smoking cessation failure as well.

Streeter, C., Terhune, D., Whitfield, T., Gruber, S., Sarid-Segal, O., Silveri, M., Tzilos, G., Afshar, M., Rouse, E., Tian, H., Renshaw, P., Ciraulo, D., & Yurgelun-Todd, D. (2007). Performance on the Stroop Predicts Treatment Compliance in Cocaine-Dependent Individuals Neuropsychopharmacology, 33 (4), 827-836 DOI: 10.1038/sj.npp.1301465

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White House Releases New National Drug Strategy

The official press statement.


The White House
Office of the Press Secretary
For Immediate Release
May 11, 2010

WASHINGTON, DC – Today, President Obama released the Administration’s inaugural National Drug Control Strategy, which establishes five-year goals for reducing drug use and its consequences through a balanced policy of prevention, treatment, enforcement, and international cooperation.   The Strategy was developed by the Office of National Drug Control Policy (ONDCP) with input from a variety of Federal, State, and local partners.

“This Strategy calls for a balanced approach to confronting the complex challenge of drug use and its consequences,” said President Obama. “By boosting community-based prevention, expanding treatment, strengthening law enforcement, and working collaboratively with our global partners, we will reduce drug use and the great damage it causes in our communities.  I am confident that when we take the steps outlined in this Strategy, we will make our country stronger and our people healthier and safer.”

The 2010 Strategy highlights a collaborative and balanced approach that emphasizes community-based prevention, integration of evidence-based treatment into the mainstream health care system, innovations in the criminal justice system to break the cycle of drug use and crime, and international partnerships to disrupt transnational drug trafficking organizations.  

During a nationwide listening tour soliciting input for the development of the Strategy, National Drug Policy Director Gil Kerlikowske met with police and medical professionals, drug treatment providers and people in recovery, elected officials, corrections officials, academics, parents groups, faith leaders, and others.  Throughout the consultation process, significant themes emerged which connect the drug issue to major Administration policy priorities, including the economy, health care reform, youth development, public safety, military and veterans’ issues, and foreign relations.

“In following President Obama’s charge to seek a broad range of input in the Strategy, I gained a renewed appreciation of how deeply concerned Americans are about drug use,” said Director Kerlikowske. “It touches virtually all of us, whether we know a family member, a friend, or a colleague who suffers from addiction or is in recovery, a police officer working to protect the community, or a parent striving to keep a child drug free,” said Director Kerlikowske.

The 2010 Strategy establishes five-year goals to reduce drug use and its consequences, including:

• Reduce the rate of youth drug use by 15 percent;
• Decrease drug use among young adults by 10 percent;
• Reduce the number of chronic drug users by 15 percent;
• Reduce the incidence of drug-induced deaths by 15 percent; and
• Reduce the prevalence of drugged driving by 10 percent.

In addition, the Strategy outlines three significant drug challenges on which the Administration will specifically focus this year: prescription drug abuse, drugged driving, and preventing drug use.  Prescription drug abuse is the Nation’s fastest growing drug problem, driving significant increases of drug overdoses in recent years.   Drugged driving poses threats to public safety, as evidenced by a recent roadside survey which found that one in six drivers on weekend nights tested positive for the presence of drugs.  Preventing drug use before it starts is the best way to keep America’s youth drug-free.  In addressing each of these issues, the Strategy outlines a research-driven, evidence-based, and collaborative approach.

New Strategy elements also include a focus on making recovery possible for every American addicted to drugs through an expansion of community addiction centers and the development of new medications and evidence-based treatments for addiction.  Continued support for law enforcement, the criminal justice system, disrupting domestic drug traffic and production, working with partners to reduce global drug trade, and innovative community-based programs, such as drug courts, play a critical role in reducing American drug use and its effects.

For more information about the 2010 National Drug Control Strategy visit www.whitehousedrugpolicy.gov.

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What Would a Genuine Drug War Look Like?

An essay on biomedicine and the body politic.

Millions of addicts in America want effective treatment, and cannot get it. Funds for research and treatment are still scarce, compared to money for interdiction and law enforcement. What would happen if we took the billions spent on interdiction and let it flow into addiction research and treatment? What would happen if we gave people truthful, accurate information about drugs, and trusted them to make intelligent decisions more often than stupid ones? Can it end up any worse that the present state of affairs?

Susan Sontag’s warnings about the danger of disease as metaphor still ring true. In modern American society, heart disease, cancer, AIDS, alcoholism, and cigarette addiction account for millions of deaths. They are all disease entities with strong psychological and behavioral components—complicated, multicellular, multi-organ disorders. But they have all been associated, at one time or another, with negative personality traits and moral flaws. The less we know about the mechanics of a human disorder, the more likely we are to view its external symptoms as signs of laziness, or neuralgia of the spirit, or as a form of damage caused by specific kinds of thoughts and emotions. Without a doubt, all kinds of flaws are sometimes expressed in the behavior of people who have these disorders. Yet none of these flaws can be considered the root cause of the diseases.

The genuine drug war is being fought in the arena of biomedicine. Addiction is being added to the roster of physical disorders once thought to be symptoms of insanity, but which are now seen to be physiological disease entities with mental components. The real crisis is the indisputable fact that there exists today an appalling shortage of funds for biomedical research. The cause of the dilemma is a fundamental misunderstanding among politicians and the public about how diseases can be understood and conquered. Research into the viral mechanisms of the common cold may ultimately yield more insights into AIDS then all of the directed research now underway. In biomedicine, there is no guarantee that goals can be reached through the front door, by a systematic assault akin to an engineering project. We cannot, for example, hope to cure addiction, or even the common cold, by means of the same methods we used to put a man on the moon.

There are, however, certain things we can do immediately, if we are serious about drug abuse. To begin with, we can attend to the staggering number of drug-related deaths, injuries, and hospitalizations caused by the abuse of prescription medications. The government itself has proven the case for this contention in numerous reports issued by the National Institute on Drug Abuse and other official bodies. According to the U.S. Department of Health and Human Services, older Americans account for more than half of all deaths from drug reactions, leading one to suspect that the majority of drug fatalities in this country stem from accidentally fatal overdoses by heavily medicated senior citizens. Our national fixation on illegal drugs has blinded us to the verifiable facts about prescription drug abuse.

We also need to recognize the problem of underprescribing morphine and other addictive painkillers for children and adults in hospital settings. One of the great scandals to come out of the drug war is the growing understanding that potent painkillers are not being offered in sufficient amounts to patients suffering intractable and agonizing pain.

“There’s a certain amount of hysteria about narcotics among doctors,” maintains one researcher.

At least half of all cancer patients seen in routine practice report inadequate pain relief, according to the American College of Physicians. For cancer patients in pain, adequate relief is quite literally a flip of the coin.

A September 10 New York Times report highlights studies by the World Health Organization which amply document the ongoing scandal in pain management. At least 6 million cancer and AIDS patients currently receive no appropriate pain treatment of any kind. In addition, WHO estimates that four out of five patients dying of cancer are also suffering severe pain. The numbers of untreated patients suffering intractable, unrelieved pain from nerve damage, burns, gunshots, sickle cell anemia, and a host of other medical conditions can only be guessed at. Typically, non-addicted patients take morphine therapeutically for pain at doses in the 5 to 10 mg. range. But experienced morphine addicts regularly take several hundred milligrams a day—a huge difference. In many cases, pain relief is the one thing doctors can offer their patients, and the one thing they withhold

These outcomes, rather than flashy cocaine seizures at the border, represent the lasting fruits of the drug war.

Photo Credit: www.foreignpolicyjournal.com

Origins of the Disease Model of Addiction

Roger Williams and “deranged cellular metabolism.”

                                                  (with Linus Pauling, 1974-------------->)

The idea of addiction as a disease first began to gain a tentative foothold in scientific and government circles in the early 1960s, after the publication of E.M. Jellinek’s The Disease Concept of Alcoholism. Jellinek may not have invented the “alcohol science movement,” as he called it, and he may not have been much of a scientist himself (the evidence suggests that he faked his doctorate), but he was the first to describe the “disease syndrome” of alcoholism—chronic relapse leading to death by liver failure. A salesman by nature, Jellinek ardently presented the disease model of alcoholism to the world of the social sciences just as zealously as he had previously done banana research in Honduras for United Fruit, and biostatistics work for Worcester State Hospital in Massachusetts. The trouble was that the “science” part of alcohol science was murky at best. No real progress was made in loosening the grip that traditional psychology exerted upon the prevailing public view of addiction.

A few years earlier, in 1959, a colorfully maverick dissenter named Roger J. Williams, professor of chemistry at the University of Texas, had proposed a specific disease model of his own; one that went all but unnoticed at the time. The late Roger Williams was best known as the biochemist who discovered vitamin B-5, commonly known as pantothenic acid, one of the so-called “anti-stress” vitamins. This discovery produced a nice revenue stream for Williams’ home university through the patents he took out on various processes for synthesizing B-5.

 One of the problems with traditional theories of alcoholism, Williams believed, was that it was very difficult to identify the specific psychosocial pathologies psychiatrists insisted were behind alcoholism—such things as infantile regression and oral fixation. Those few researchers who did pay attention to alcoholism, he asserted, “have been so diverted by the rather vague and ill-defined personality disorders that alcoholics allegedly have that they have failed to concentrate upon the one thing that all alcoholics have—whether they are rich or poor... introverts or extroverts, dominant or submissive, repulsive or charming—namely, an excessive appetite for alcohol.”  The idea of appetite was, for Williams, the essential semantic shift. As Williams insisted in his book, Alcoholism: The Nutritional Approach:

“Alcohol is a physiological agent and the urge which the initial drink produces, in my opinion, arises because of deranged cellular metabolism. Except for the fact that derangement is involved, the urge is fundamentally similar to the urge we have for water when our tissues become dehydrated, for salt when our tissues become salt-hungry... or the unfortunate craving some diabetics have for sugar....”

Dr. Williams was saying that after a certain point, the burning urge for alcohol, or the insatiable craving for heroin became, for “addiction-prone” people, indistinguishable from the primal drives of food, thirst, or sex. “This is something that it is impossible to understand unless we take into account the tremendous biochemical individuality that exists.” If alcohol and addictive drugs didn’t effect you that way, well then, they just didn’t, and you thanked your lucky stars for it, the way you would be thankful for not having allergies or diabetes. Blood composition, enzyme levels, endocrine activities, excretion patterns, and nutritional needs all vary from person to person, argued Williams, and the effect of any given addictive drug was going to vary widely from person to person. This neglect of biochemical individuality, Williams was convinced, was the reason physicians had no medical treatment to offer. They had the wrong paradigm—they were focusing on the drugs themselves, and not on the bodies and brains of the users.

There were, Williams insisted, periodic references in the literature to what he called the “X” factor—some particular defect, or excess, or absence, that was present in alcoholics, but absent in moderate drinkers and abstainers. The hunt for the X Factor, for Substance H, was fast becoming the Holy Grail of addiction research.

Williams thought the X factor was genetic.

Photo Credit: http://bioinst.cm.utexas.edu