Sunday, December 18, 2011

Heavy Drinking Impairs Serotonin Function More Rapidly in Women


My article on women and alcohol.

There are very real gender differences in the way men and women are affected by alcohol. Here's my summary of the subject in a December 16 article for Scientific American Online:

"Women's Response to Alcohol Suggests Need for Gender-Specific Treatment Programs"

A new study underscores that the physical consequences of alcoholism appear faster and are more severe for women than for men...

Article continues HERE.

Monday, December 12, 2011

A Six-Pack of Prior Posts


Don’t fear the chemistry. 

This isn’t a top 10 list, just a compilation of five previous posts here at Addiction Inbox that have continued to draw reader interest since they were first published. If there is a theme running through this set, it is neurochemistry at its most basic level. Take a look, if any of the subjects interests you. (My most popular post of all, on Marijuana Withdrawal, has turned into a self-help message board. I note it here, but leave it off the list, as it has become a blog of its own for all practical purposes.)
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1) Don’t let anyone tell you that the basic notions involved in neurotransmitter action in the brain are over everyone’s head. This post about serotonin and dopamine basics has always been popular, partly because serotonin and dopamine have gone from obscure abstractions to pop buzzwords. But I think it also shows a growing awareness of brain science and its real-world applications among interested readers.

“…. Addictive drugs have molecules that are the right shape for the amine receptors. Drugs like LSD and Ecstasy target serotonin systems. Serotonin systems control feeding and sleeping behaviors in living creatures from slugs to chimps. Serotonin, also known as 5-HT, occurs in nuts, fruit, and snake venom. It is found in the intestinal walls, large blood vessels, and the central nervous system of most vertebrates. The body normally synthesizes 5-hydroxytryptamine, as serotonin is formally known, from tryptophan in the diet….”

Serotonin and Dopamine: A primer on the molecules of reward
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2) Continuing on the chemistry theme, this post on anandamide, the brain’s own form of internal marijuana, has garnered steady attention since 2008. It may be coincidental, but the post also makes mention of serotonin and dopamine.

“…Several years ago, molecular biologists identified the elusive brain receptor where THC, the active ingredient in marijuana, did its work. Shortly after that discovery, researchers at Hebrew University in Jerusalem identified the body’s own form of THC, which sticks to the same receptors, in pulverized pig brains. They christened the internally manufactured substance “anandamide,” after the Sanskrit ananda, or bliss…”

Anandamide, the Brain’s Own Marijuana: Anxiety and the THC receptor.
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3) Interest in the anti-craving drug Topamax, an anti-seizure medication used to treat alcoholism, remains strong with blog readers, although the drug has not become the universal blockbuster many advocates had hoped.

“…Dr. Bankole Johnson, chairman of Psychiatry and Neurobehavioral Sciences at the University of Virginia, told Bloomberg News that Topamax does everything researchers want to see in a pharmaceutical treatment for alcoholism: “First, it reduces your craving for alcohol; second, it reduces the amount of withdrawal symptoms you get when you start reducing alcohol; and third, it reduces the potential for you to relapse after you go down to a low level of drinking or zero drinking…"

Topamax for Alcoholism: A Closer Look. Epilepsy drug gains ground, draws fire as newest anti-craving pill
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4) One of the most popular posts to date was this examination of neurological questions surrounding marijuana and memory loss. Inquiring minds, uh, forget the question. Oh yeah: Does the strain of dope you smoke determine how forgetful you’ll become?

“…As far as memory goes, THC content didn't seem to matter. It was the percentage of cannabidiol (CBD) that controlled the degree of memory impairment, the authors concluded. "The antagonistic effects of cannabidiol at the CB1 receptor are probably responsible for its profile in smoked cannabis, attenuating the memory-impairing effects of THC. In terms of harm reduction, users should be made aware of the higher risk of memory impairment associated with smoking low-cannabidiol strains of cannabis like 'skunk' and encouraged to use strains containing higher levels of cannabidiol..." 


Marijuana and Memory: Do certain strains make you more forgetful?
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5) Finally, a popular post focusing on the biochemistry of nicotine in e-cigarettes, the new, smokeless nicotine delivery system. Are they safe? The latest in harm reduction strategies, or starter kits for youngsters?

“…You may never have heard of it—but it’s the newest drug in town. It’s called an electronic cigarette, or “e-cigarette.” Electronic cigarettes use batteries to convert liquid nicotine into a fine, heated mist that is absorbed by the lungs. No smoke, but plenty of what makes cigarettes go, if you don’t account for taste—or ashtrays and smoke rings….”

E-Cigarettes and Health: Smokeless nicotine comes under scrutiny.

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

Thursday, December 8, 2011

Nothing Organic About Rodale’s New Book on Addiction


Raw carrots won’t cut it.

How times have changed. You’ve heard of Rodale, the outfit that kicked off organic gardening in America, and publishes Prevention Magazine and Organic Gardening? Founded in 1947, the Rodale Institute’s mandate was to publicize J.I. Rodale’s personal vision of healthy soil and healthy food. So it was with great astonishment that I picked up The Addiction Solution: Unraveling the Mysteries of Addiction Through Cutting-Edge Brain Science, published by Rodale Books, heretofore famous for such perennials best sellers as The Rodale Book of Composting, The Rodale Whole Foods Cookbook, Diabetes Without Drugs, and The Organic Manifesto.

So what is the approach taken in this new paperback about addiction? Herbal treatments for alcoholism? Fresh air and sunshine for meth addiction? No. The “brain science” in the subtitle is really just that. Written by Dr. David Kipper, a Beverly Hills physician, and Steven Whitney, a former addict, the book states that addiction is… er… a brain disease, and not primarily a behavioral issue. It seems that Big Science has gotten its murderous dissecting hands around the Rodale organization at last. In neuroscience, not organic carrots, lies the future of addiction treatment, the book asserts. Is old man Rodale turning over in his grave? It gets worse. The Rodale organization is now saying, through this book, that if you are an addict, you might want to consider taking… more drugs.

Here it is, in a nutshell: “An inherited genetic flaw causes specific imbalances in brain chemistry, that, when impacted by stress, create biochemical ‘wantings,’ or needs, that show themselves as bad feelings, uncharacteristic behaviors, and/or addiction, which is medically treated by a new family of pharmaceutical medications that first regain and then stabilize the biochemical balance. During the rehabilitation of the brain chemistry, the patient enters a personalized recovery program featuring behavioral and other therapies.”

You can argue with certain specifics in that definition—“brain imbalance,” for example, is falling out of favor as a descriptor—but there is no denying that it represents an attempt at a strictly neurophysical definition of the condition.

Traditional addiction treatment, the book argues, hasn’t included any of this. The authors maintain that “traditional 28-day inpatient programs at treatment centers are now largely unnecessary. This is good news, since that kind of treatment costs from $50,000 to $100,000 per month.” [Editor’s note: perhaps in Beverly Hills.]

“In contrast,” the authors write, “the new medical paradigm is grounded in outpatient treatment, making it more affordable, especially with insurance and government benefits that define addiction as a medical disease. Thanks to the Mental Health Parity and Addiction Equity Act of 2008, insurers that offer substance abuse coverage must provide the same lifetime limits on payment as they provide for other medical diseases like diabetes, heart disease, and cancer.”

And what does all this accomplish? “More subtly, the new approach replaces the expectation of failure attached to the old, traditional treatment with a tangible opportunity for success, including raising an addict’s self-esteem.” Away with your old and traditional ways, says this Rodale title. If you are looking for an organic alternative to what is becoming the mainstream view of addiction, you will have to look elsewhere. Perhaps Prevention magazine might have something more in your line.

Graphics Credit: http://metalmother.com/

Friday, December 2, 2011

Is Coumadin the Most Dangerous Drug in America?


Common drug most likely to land seniors in the hospital.

High-risk drugs for seniors aren’t the ones you might think. Take warfarin, trade name Coumadin. Millions of seniors do. For people with certain kinds of heart trouble, or who have had a stroke, Coumadin works against the blood’s tendency to clot, and saves lives. In cases of accidental overdose, however, it causes uncontrolled bleeding, and is the likeliest drug to put people over 65 in the emergency room. To further complicate matters, Warfarin interacts with a number of common medications, such as antibiotics, in ways that alter the blood’s clotting ability.

A team of researchers from the Centers for Disease Control and Prevention (CDC) and Emory University studied almost 100,000 emergency hospitalizations due to adverse drug events between 2007 and 2009. The results, published in the New England Journal of Medicine, showed that nearly two-thirds of such hospitalizations were due to hemorrhages caused by unintentional overdoses, and that warfarin was the leading culprit, accounting for about one third of the admissions and costing “hundreds of millions of dollars annually.” Prescription painkillers and sedatives, generally considered to be a major hazard for seniors, account for a mere fraction of hospital admissions—about 1.2%.

Accidental overdoses of insulin products came in second, followed closely by anti-coagulant drugs like Plavix and aspirin. The study makes clear that the main danger for seniors is hemorrhages and other forms of uncontrolled bleeding. In addition, insulin overdose can cause fainting and seizures, and it is not uncommon for those over 65 to be taking drugs for both diabetes and heart disease at the same time.

Half of those hospitalized for drug emergencies were over the age of 80, according to the study, which says that drug-related hospitalizations can only grow as the population ages. 40% of Americans over the age of 65 take five to nine medications, the study revealed.

Clearly, doctors can cut down on admissions and save money by more closely monitoring medications in older patients. But the sad fact is that physicians don’t do a very good job of keeping track of all the medications older patients may be taking. Michael R. Cohen of the Institute for Safe Medication Practices told the Wall Street Journal that pharmacists needed to step into the information gap: “When you get a prescription filled, you’re handed a patient education sheet that’s a printout from the computer,” he said. “It’s very difficult to read, so it generally ends up in the trash.”

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

End of the Line for Joe Camel?


The tobacco industry’s war against plain packaging.

After years of tightening regulation and dramatic declines in the number of adult smokers, Big Tobacco is targeting teenagers like never before. The fact that they intend to do it with aggressive package advertising has run up against plans in the U.S., the U.K., and Australia to force cigarette manufacturers to use plain packages in a neutral color, with no brand logos, more graphic warnings, and the brand name in simple typeface.

In an orchestrated attack on cigarette regulation in the UK, tobacco giant Philip Morris, the world’s largest tobacco company, filed a flurry of Freedom of Information Act requests in September designed to give them access to proprietary academic research on teenage smoking habits….

For more, read my entire article at THE FIX....

Tuesday, November 29, 2011

The Triumph of Synthetics


Designer stimulants surpass heroin and cocaine.

A troubling report by the United Nations Office on Drugs and Crime (UNODC) shows that amphetamine-type stimulants (ATS) have, for the first time, become more popular around the world than heroin and cocaine. Marijuana remains the most popular illegal drug in the world, and the use of amphetamines has fallen sharply in the U.S., but the world trend represents the worldwide triumph of synthetic drug design over the plant-based “hard drugs” of the past.

The 2011 Global ATS Assessment estimates that in 2009, some 14 to 57 million people aged 15-64 took an amphetamine-type substance during the year.  The category includes methamphetamine, synthetic stimulants known as bath salts, and Ecstasy. For ecstasy, which is grouped with the ATS family because of its speed-like qualities, “global annual prevalence” stood at only 11-28 million past-year users in 2009, basically unchanged.  Not so for the use of the new synthetic methamphetamines—compounds such as mephedrone, 4-methylmethcathinone (4-MMC) and MDPV, which first took off in the UK, Canada, and New Zealand. In fact, bath salts in the form of mephedrone are competing with ecstasy as the club drug of the moment. (Ecstasy seizures are currently at a 5-year high in the United States, so the window for alternatives is currently wide open.) Meanwhile, recorded worldwide use of heroin, cocaine, and marijuana remained essentially steady from 2005 to 2009.

So what’s behind the global surge in production of amphetamine-type drugs? What advantages do these stimulants hold over time-tested drugs like heroin and coke?  And why is it happening now?

                                                      Emerging Markets

The seismic changes in worldwide drug production begin with geography. Amphetamine-type stimulants are spreading to new regions, and are now being manufactured in places previously off the radar—Iran, Malaysia, and West Africa, for starters. The UNODC report notes that synthetic stimulants “offer criminals a new entry into unexploited and fresh markets.” The locus of activity is no longer the opium fields of Afghanistan, or the coca plantations of Columbia. In absolute numbers, the report claims, “most ATS users live in Southeast Asia, the most populous subregion the world.”

The growing number of methamphetamine pills seized in Southeast Asia is staggering: “The 93.3 million methamphetamine pills seized in 2009 in China, Lao People’s Democratic Republic, Myanmar and Thailand represent a three-fold increase in comparison with 2008 figures,” the UN report alleges. “In 2010, total seizures surpassed 133 million pills.” Not since the Japanese amphetamine scourge of the post-World War II years has East Asia seen anything like this.

 The UN report singles out two new countries—Lao People’s Democratic Republic, and Malaysia—as nations reporting, for the first time, “the injecting use of crystalline methamphetamine in 2008 and 2009.” And a massive increase in production has been documented in northern Burma. Voice of America News reports that amphetamine-type drug seizures in Burma went from one million pills in 2008 to a mind-blowing 23 million pills a year later.

A regional representative for the UNODC in East Asia said that the seizures “reflect a dramatic increase in production in the Shan State” in Northern Burma. The production of methamphetamine is a primary source of income for the Shan, whose territory is near the borders of China and Thailand. “What we are worried about,” said the UNODC rep, “is the nexus of drugs, of weapons, of money that is moving around that region at a time when elections are pending and the political situation is quite fragile.” At the same time, Burma remains a major supplier of opiates, though competition with Afghanistan may have helped encourage the production of illegal stimulants. UNODC Executive Director Yury Fedotove explained that the market for synthetic stimulants “has evolved from a cottage-type industry typified by small-scale manufacturing operations to more of a cocaine or heroin-type market with a higher level of integration and organized crime groups involved throughout the production and supply chain.“

                                                    Homegrown vs. Manmade

Amphetamines, in all their synthetic forms, have several production advantages over plant-based addictive drugs like heroin and cocaine. In recent years, the U.S. and other countries have cracked down on amphetamine precursor drugs like ephedrine and pseudoephedrine. Once these tried and true compounds for amphetamine manufacture—found in cold and allergy medications—were registered and controlled, traffickers made the switch to different chemical approaches. New building blocks like phelylacetic acid and l-phenylacetylcarbinol (l-PAC) have been found in labs from Canada to Mexico. Growers of opium and coca have no such alternatives available to them. Pharmacologist David Kroll, Professor and Chair of Pharmaceutical Science at North Carolina Central University in Durham, who has been following the new synthetic drug products on his blog, Terra Sigillata, said that ome of the latest precursors have a problematic history. “Phenylacetate and phelylacetic acid have been investigated in clinical trials for cancer and in the treatment of sickle cell disease,” said Dr. Kroll. “But they didn’t fare well in large clinical trails because they required such high doses, and patients had side effects.”

While this is definitely not a reliable class of compounds from which to fashion new recreational stimulants, Dr. Kroll noted that rendering synthetic drugs illegal can sometimes play havoc with efforts to develop the same drugs for therapeutic purposes. “If these precursors become more strictly regulated, there might be an untoward effect on the prices of other drugs” that use the same compound as a building block, he said.

                                                               New Players

Drug lab seizures in Jordan, Syria, and the United Arab Emirates have also reached new highs—particularly the clandestine manufacture of a form of amphetamine called phenethylline, marketed under the brand name Captagon. Very little in the way of equipment or startup capital is required, which facilitates new players in this market. Captagon, said Dr. Kroll, “makes pretty good sense. The body can metabolize it to amphetamine itself—it’s an amphetamine pro-drug. The other metabolite of the drug is theophylline, the old asthma drug that also acts as a mild stimulant. But it’s potentially as dangerous as amphetamine, depending on how efficient one’s metabolism is.” This is, of course, a huge problem: One bath salts user might have an acceptable drug experience, while another might find that a few whiffs of the same synthetic stimulant will land him or her in the emergency room, with a dangerously elevated heart rate or other complications.

What drug designers, drug manufacturers, and drug suppliers have come to realize is that methamphetamine and other ATS drugs appear to fill the lifestyle void left by the uncertain supply and pricing situation associated with cocaine. Everywhere they land, synthetic stimulants—from biker crank to mephedrone—wreak instant havoc. They simply are not predictable compounds. One bath salts user compared the experience to “a shot of methamphetamine with a PCP chaser." From any kind of rational sociocultural point of view, these are not safe drugs. And it hardly needs repeating that they are highly addictive for many people. The legalization of amphetamine is not a cause likely to gain much momentum any time soon.

Even though the United States has a long history of dealing with amphetamine, this is manifestly not true of every country in the world. And now these untapped markets are fair game for cheaper, longer lasting amphetamine-type stimulants, which “seem to appeal to the needs of today’s societies and have become part of what is perceived to be a modern and dynamic lifestyle,” according to the UNODC report.

We don’t know with complete certainty that the drug data coming out of several key areas—Southeast Asia, Africa, and the Middle East in particular—is accurate. Authorities have captured and dismantled ATS labs in Central and South America as well. In all likelihood, drug production and use in all these regions is underreported. The UNODC document laments that “household and other surveys are lacking or are outdated in some countries in several of the most affected regions.” This is a particular problem in China and India, where no serious national survey of amphetamine-type stimulants has ever been undertaken.

We have a long way to go before we know the outcome of the current craze for synthetic stimulants. The historical wreckage caused by injected methedrine in the 60s and 70s, and smokable ice in the 90s and the aughts, is a grisly matter of public record. Now we are confronted with a baffling cornucopia of designer concoctions whose track record for safe recreation is, thus far, not so good. Amphetamine drugs have sent thousands to their deaths, and countless others to the emergency rooms. And now this deadly deck of stimulants has many more cards in it than it did just a few years ago. Pick a card, any card. First one’s free.

Photo Credit: http://teens.drugabuse.gov/

Friday, November 25, 2011

Drug Addiction in 10 Slides or Less


Dr. David Friedman explains it all.

Dr. David Friedman, a professor of physiology and pharmacology at Wake Forest University School of Medicine, is also the co-founder and director of the Addiction Studies Program, a workshop for science journalists in Washington, D. C., funded by the National Institute on Drug Abuse (NIDA).

Sometimes it helps to step back and attempt to make the scientific case for addictive disorders as simply as we are able. Herewith, some highlights from Dr. Friedman’s useful presentation at the recent Addiction Studies Program workshop. Slides reproduced with Dr. Friedman’s kind permission. The comments adjacent to the slides are my own, as are any errors of fact or interpretation.

 There are important distinctions to be made between drug abuse and drug addiction, as Dr. Friedman makes clear in the slide to the right and the slide below. Unfortunately, government agencies have tended to take the position that any drug use is ipso facto drug abuse; a political position not well supported by the relevant science


  As a chronic medical condition, or “brain disorder,” addiction has a fair amount in common with other diseases, like hypertension, asthmas and diabetes, Friedman said. Relapses and setbacks are frequent, but not found in every case. 

  The key questions, indeed: What is different about the brains or the genes or the nerve cells of those who become dangerously addicted, compared to those who can take it or leave it? Scientists have discovered various so-called “markers” over the years in the brains of the children of adult alcoholics, but none of these have been broad enough in scope to point toward anything like an effective near-term treatment. However, the recent shift from chasing genes to studying neurobiological brain processes is a hopeful turn of events.

Again, a crucial distinction must be made between a state of physical dependence (at right) and a state of withdrawal (below). Non-addicts can become physical dependent on a variety of prescription medications. Such physical dependence precedes a full-blown state of addiction, but is not to be confused with addiction itself.

 The symptoms and intensity of drug withdrawal can vary from horrifying to essentially non-existent. It depends upon the drug, the drug taker’s metabolism, the social setting, environment and expectations of the users, etc. Craving and withdrawal represent the basic mechanism responsible for relapse.

 Most people are familiar with the “rebound effect” sometimes produced by over-the-counter nose sprays. Whey you inhale these medications regularly enough, the result of going turkey is… a profoundly stuffed-up nose.

In an effort to expand on the “chronic disease of the brain” label affixed by former NIDA director Alan Leshner, Dr.Friedman directs our attention toward specific brain mechanisms: reward, motivation, and memory.

Addiction is a pediatric disorder, Friedman emphasizes. This is particularly true with marijuana abuse and addiction.  Lke sugar in your blood, you can choose to control the amount of drugs you take, but you cannot choose your reaction to them.

We know for certain these days that adolescent brains are not yet fully formed, and that adolescent brains react to drugs differently than adult brains. For example, recent studies show that the actual composition of adult nicotine receptors in the brain is affected by exposure to nicotine in adolescence.


The net result of all this? Things happen at the biochemical level that change how things play out at the behavioral level.







Photo Credit: http://www.wakehealth.edu/
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