Greater brain risks from ecstasy use

NEW YORK (Reuters Health) - For a glimpse into real-world drug use, Australian researchers went to parties where people were using a drug known as ecstasy - and discovered that users' brains were at far more risk from the drug than anyone had suspected.

The researchers also found that ecstasy pills often contain a variety of other drugs.

"What's concerning is that most studies looking at toxicity in people or animals look at a single drug," said Dr. Thomas Newton, a professor at Baylor College of Medicine, who was not involved in this study.

"We have no idea what happens when you start mixing like this."

For this study, 56 people who had taken ecstasy at least five times in the past agreed to invite the researchers to house parties where they took ecstasy once again.

The researchers collected a sample of the pills and measured users' blood levels of MDMA - the chemical that's in ecstasy - every hour for 5 hours after people took the drug. At the end of the study, each user received AUS$200 (about US$205, or 128 GBP) for participating.

In some people, the amount of MDMA reached levels that cause injury or death in primates.

The researchers found that only half of the pills consisted entirely of MDMA. The other half also contained methamphetamine or chemicals related to MDMA: MDEA or MDA.

Some pills had no MDMA at all. The ones that did had amounts that ranged widely, from as low as 25 mg to ten times that amount.

"This highlights a significant public health concern, particularly regarding the existence of pills containing more than 200 mg of MDMA," the authors write in their report of the study, which is published in the journal Addiction.

Because the research was intended to capture a realistic snapshot of ecstasy use, the number of pills people took over the course of an evening varied as well. Most users ingested more than one pill; some people took as many as five.

"Taking multiple pills is likely to lead to very high blood concentration, which may be harmful," Dr. Rod Irvine, the lead author of the study, wrote in an email to Reuters Health.

That's because concentrations of MDMA in users' blood did not stop climbing during the 5 hours of sampling.

"We were surprised that the...concentrations continued to rise throughout the study," Irvine, a professor at the University of Adelaide, said. "The higher levels are approaching those that have been shown to be damaging to brain cells in animal models."

Three users had blood concentrations greater than 700 mg/L, which was poisonous to primates in laboratory studies. Another three users had concentrations very close to that level.

"Those are big numbers," Newton said of the blood concentrations.

Irvine said that most users continued to take more ecstasy throughout the night, even though their blood concentrations from the initial pill had not peaked.

The authors speculate that users might develop a tolerance to the drug while they're using it, making them feel less intoxicated even while their blood levels of the drug are increasing.

None of the users in the study suffered any immediate health problems from taking ecstasy.

According to the US National Institute on Drug Abuse, ecstasy can interfere with heart rate and temperature regulation and can cause brain damage.

Seven of every 100 twelfth-graders say they have tried ecstasy.

Irvine said that collecting data at parties is a valuable way to get a sense of what people are actually exposing themselves to.

For instance, in 14 people the amount of MDMA in the blood reached levels that had never been studied in humans in the lab.

In laboratory studies, ethical considerations prevent researchers from testing such high doses in people, so the amounts they experiment with "do not reflect the range used naturally," Irvine wrote.

Regarding the information Irvine's team collected, Newton said, "It's very unique to pull that off."

The research was funded by the National Health and Medical Research Council of Australia.

Difference Between Alcoholism and Alcohol Abuse

Alcoholism and alcohol abuse are the two typical types of human disorder that involves uncontrollable desire and intake of alcoholic drinks despite all its bad effects to the body. They are most commonly known as alcohol addicts and are mostly common to men.

The term Alcoholism was coined by a physician from Sweden, Magnus Huss, around 1849 and replaces the term Dipsomania or the craving and intense thirst of one person over alcohol. But during the 1980s, the committee from the World Health Organization did not agree on the use of the term for diagnostic purposes that is why they changed it to “alcohol dependence”.

Alcohol abuse is a diagnostic term that involves a person’s psychiatric disorder of repetitive use of any beverages with alcohol content. According to a certain psychiatry book, alcohol abuse can contribute to a person’s decision to commit suicide especially if the person is suffering from a great depression. Constant alcohol abuse may lead a person to another disorder known as alcohol dependency.

Alcoholism superseded the term dipsomania which means a strong desire and intense thirst of a person over alcoholic drinks. But around 1979, alcohol abuse superseded the term alcoholism due to the World Health Organization’s recommendation to change the term for specific reasons. Physical signs of a person suffering from alcoholism involve sexual dysfunction, epilepsy and deficiency of one’s nutrition. Alcohol abuse, on the other hand, shows signs like insomnia and irritability. Alcoholism prevented measures by the WHO involves increasing the age limit before someone is allowed to drink. Increasing the tax of alcoholic beverages can reduce alcohol abuse, too.

Just like any other kind of addiction in the medicine world, alcoholism and alcohol abuse are addictions over alcohol that can still be treated. Those who suffer with any of these types of alcohol addiction can either go for a rehabilitation program to ensure proper withdrawal and/or with the use of doctor-prescribed medicinal drugs for alcoholism and alcohol abuse.

In brief: • Alcoholism replaces the term dipsomania in the same way that alcohol abuse replaces the term alcoholism due to the recommendation of the experts in World Health Organization. • Alcoholism signs and symptoms includes but not limited to nutritional deficiency, sexual dysfunction and epilepsy while alcohol abuse includes insomnia and irritability.

In Drug Courts, Judges Practice Their Own Version of Justice - And "Treatment"

Drug courts must be standardized, they must be held accountable and they must not be our primary policy approach to drug use and addiction. 

In Glynyears of her life in a dark, unexamined corner of the American criminal justice system.

Superior Court Judge Amanda Williams, who runs the Glynn County drug court, thought she was running her drug court according to national standards. The National Association of Drug Court Professionals (NADCP) says she’s got it all wrong. Judge Williams’ drug court may be unique. But, according to a new report by the Drug Policy Alliance, drug courts across the country exhibit similar (though , one hopes, less extreme) problems.

How is it that Judge Williams is free to steal a decade of Ms. Dills’ life, wreak similar havoc in the lives of so many others and remain on the bench? The fact is that, in drug courts across the country, the judge is king – and doctor.

The NADCP works to educate judges and other court personnel about addiction, to urge drug courts to focus on people with a history of law-breaking that is linked to a drug problem (rather than people facing a first-time drug charge), and to emphasize that incarceration does not “treat” addiction. Like other industry groups, it also serves to promote drug courts through public relations campaigns and to secure increases in federal funding for the programs. The NADCP has no authority over the nation’s more than 2,000 drug courts and, as a spokesperson tells This American Life, the group is aware of at least 150 drug courts that do not operate according to the best practices it promotes.

The Drug Policy Alliance is concerned that the number of drug courts whose practices may actually increase the criminal justice involvement of people struggling with drugs – as well as of people who do not have a drug problem but are convicted of a drug law violation – may be far greater.

Drug courts are locally developed and locally run. In them, judges have near complete freedom to choose who to accept, what kind of treatment to mandate, who to incarcerate and for how long and when to deem a participant a “success” or “failure.” They lack national standards and, worse, are not accountable to any authority.

Despite the NADCP’s recommendation that drug courts focus on cases involving people who have lengthy criminal histories and who actually have a drug problem, for example, a national survey found that roughly half of drug courts exclude people on probation or parole or with another open criminal case, 49 percent actually exclude people with prior treatment history and almost 69 percent exclude those with both a drug and a mental health condition.1 Another national survey found that fully one-third of drug court participants do not have a drug problem.

Disputes over legalization of medical-marijuana dispensaries

Unleashing potential dangers

Eighty percent of people who smoke marijuana to relieve their symptoms of illness smoked it before they came down with their ailment to begin with. For every supposed indication of marijuana use, there is another drug that has actually been shown to work better [“Sign medical-pot bill,” Opinion, April 19].

If it really had medicinal benefits, why don’t the active ingredients when taken as a pill seem to work?

If marijuana becomes a legal substance, the human toll (especially on the young) will be huge. Alcohol-abuse cases already fill the emergency room at Harborview Medical Center. It is the cause behind some domestic-violence cases and has destroyed the lives of countless young people.

Why unleash another mind-altering drug into our society? Those with mental illness will be at the greatest risk and their chances for recovery will be greatly diminished.

Some of us have no idea how to get pot even if we wanted to take some. Medical marijuana is just a ploy to legalize a dangerous, gateway drug.

Youth Drinking

SURGEON GENERAL'S CALL TO ACTION TO PREVENT AND REDUCE UNDERAGE DRINKING 

Introduction to the Surgeon General's Call to Action To Prevent and Reduce Underage Drinking At a March 6, 2007 news conference, Acting U.S. Surgeon General Kenneth P. Moritsugu issued the Call to Action To Prevent and Reduce Underage Drinking, appealing to the Nation to do more to stop current underage drinkers from using alcohol, and to keep other young people from starting. In this first Call to Action addressing underage drinking, Dr. Moritsugu laid out recommendations for government and school officials, parents, other adults, and young people. “Too many Americans consider underage drinking a rite of passage to adulthood,” said Dr. Moritsugu, in a news release. “Research shows that young people who start drinking before the age of 15 are five times more likely to have alcohol-related problems later in life. New research also indicates that alcohol may harm the developing adolescent brain. The availability of this research provides more reasons than ever before for parents and other adults to protect the health and safety of our nation's children.” The news release cites research from the 2005 National Survey on Drug Use and Health, which estimates there are 11 million underage drinkers in the United States. Nearly 7.2 million are considered binge drinkers, typically meaning they drank more than five drinks on occasion, and more than 2 million are classified as heavy drinkers. Developed in collaboration with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), the Call to Action identifies six goals that:

• Foster changes in society that facilitate healthy adolescent development and help prevent and reduce underage drinking;
• Engage parents, schools, communities, all levels of government, all social systems that interface with youth, and youth themselves in a national effort to prevent and reduce underage drinking and its consequences;
• Promote an understanding of underage alcohol consumption in the context of human development and maturation that takes into account individual adolescent characteristics as well as environmental, ethnic, cultural, and gender differences;
• Conduct additional research on adolescent alcohol use and its relationship to development;
• Work to improve public health surveillance on underage drinking and on population-based risk factors for this behavior; and
• Work to ensure that policies at all levels are consistent with the national goal of preventing and reducing underage alcohol consumption.

“Alcohol remains the most heavily abused substance by America's youth,” said Dr. Mortisugu. “This Call to Action is attempting to change the culture and attitudes toward drinking in America. We can no longer ignore what alcohol is doing to our children.”

For a description of the Call to Action and the companion guides, see the Call to Action Publications page.

 

Leadership Response Leadership Co-Chair Mary Easley, First Lady of North Carolina, and Leadership Foundation board member Michele Ridge, former First Lady of Pennsylvania, spoke at the March 6 news conference, lauding the new report, and promising that Governors’ spouses and representatives around the country will use it to mobilize people in their States. Leadership’s goal is to work with this Surgeon General and future Surgeon Generals to highlight prevention of childhood drinking. To accomplish this goal, Leadership is holding news conferences and town meetings focused on the Call to Action, giving speeches and writing articles on childhood drinking, and working with State and local lawmakers to find effective ways to deny children access to alcohol, promote research and treatment programs, and other activities. See the Surgeon General in the States page for information on individual State activities.

Facts On Underage Drinking By Option

Underage drinking cost the citizens of The United States $68.0 billion in 2007. These costs include medical care, work loss, and pain and suffering associated with the multiple problems resulting from the use of alcohol by youth.1 This translates to a cost of $2,280 per year for each youth in the State. Excluding pain and suffering from these costs, the direct costs of underage drinking incurred through medical care and loss of work cost the United States $22.3 billion each year.

Youth violence (homicide, suicide, aggravated assault) and traffic crashes attributable to alcohol use by underage youth in the United States represent the largest costs for the State.  However, a host of other problems contribute substantially to the overall cost.  Among teen mothers, fetal alcohol syndrome (FAS) alone costs the United States $1,227 million. Check the Underage Drinking Enforcement Training Center for data on costs for your state.

 

Option One:  Reach Children with Problems Early 

• Nearly 8000 children between the ages of 12 and 17 start to drink each day in the USA. [SAMHSA]
•  In 2007, 7.8 percent of people age 12 or older—an estimated 19.3 million people—needed treatment for an alcohol problem in the past year. [SAMHSA]
• 18- to 20- year-olds have the highest prevalence of DSM-IV Alcohol Dependence [ NSDUH]
• 5.5 percent of youth ages 12-17 meet the diagnostic criteria for alcohl abuse or dependence [NSDUH, SAMHSA]
• Annually 2,500 Ohioans, ages 12-20, are admitted for alcohol treatment [ ODADAS] { check with your single state agency for similar data for your state}
• As many as 300,000 fourth and fifth graders (3.7% of fourth graders and 4.6% of fifth graders) begin drinking alcohol before reaching the sixth grade [Pride Survey, 2009]. These students are between 9 and 11 years old. http://www.pridesurveys.com/customercenter/ue08ns.pdf

  Option Two: Remove Access and Incentives  

• Alcohol use increases dramatically during adolescence. About 15% of 12 year olds have had a whole drink; by age 15, approximately 50 % of boys and girls have had a whole drink of alcohol; by age 21, approximately 90 percent have done so. [ NSDUH, SAMHSA] 
• Underage drinkers account for 21.1 percent of all the alcohol consumed in Ohio. [?CASA, 2003]
•  [??? look at the CASA report for your state data]
• A survey of over 6000 teenagers revealed : Teenagers usually get their alcohol from persons 21 or older. The second most common source for high school students is someone else under age 21, and the second most common source for 18- to 20-year-olds is buying it from a store, bar or restaurant (despite the fact that such sales are against the law).[APIS, NIAAA]
• 76 percent of Ohio students in grades 9-12 have consumed alohcol. [YRBS] - You can check out your state data on the Links from the State Data Page.
• Research suggests that people who have expectations of more positive experiences form drinking tend to drink more that others and are at highest risk for excessive drinking. Children in general shift from a primary emphasis on the negative and adverse effects of drinking alcohol before age 9 to a primary emphasis on the positive and arousing effects of alchol by about age 13. [US Surgeon Genreal Call to Action, 2007]
• In 1998, States spent $81.3 billion – 13% of their budgets to deal with the substance abuse and addiction. For each dollar, 96 cents went to shovel up the wreckage of substance abuse and addiction and only 4 cents wne to prevent and treat it. [CASA, see their website for state by state data]

  Option Three: Help Children through Difficult Times in Development  

• Children need help growing up safe and healthy.
• Children who start to drink alcohol before the age of 15 are at great risk for short and long-term consequences, such as other substance abuse problems, risky sexual behavior, unintentional injuries, car crashes, and physical fights. [US Surgeon General Call to Action to Prevent and Reduce Underage Drinking, 2007]
•  Adolescence isa time of heightened risk taking, independence seeking and experimentation, and alcohol has been shown to impair one’s ability to evaluate risk and reward when making decisions. [US surgeon General Call to Action, 2007]

Formal Conversations/Deliberations: Where and How?

Formal Conversations
 

Formal conversations are more like deliberations where a group of persons discuss the reasons for and against a measure or solution.  In this instance, three options (solutions) have been proposed around which the deliberation will occur.  These include:

• Option One:  Reach Children with Problems Early
• Option Two:  Remove Access and Incentives; and
• Option Three:  Help Chidren through Difficult Times in Development

These deliberations often end with some sort of follow-up action.  Perhaps it is an individual parent/guardian who resolves to talk to their child about alcohol, or perhaps it is a group of individuals who want to band together to build or enhance community efforts designed to  implement the proposed solutions.  For more information on deliberations, visit the National Issues Forum website.

When organizing a formal conversation/deliberation/forum, the first thing to remember is that YOU ARE NOT ALONE.  Who would be interesed in the issue of childhood drinking and who might be willing to help organize a formal conversation:

1. Librarians, parent associations, teachers, and school administrators are valuable sources of information about youth, peer groups, and youth trends.
2. Service clubs, churches, and faith-based organizations are groups that cut across every facet of community life; partnering with them proves the odds of having broad and diverse participation.
3. It is important to get views from people whose voices or perspectives are not often heard in public forums. Childhood drinking is an issue that affects families at all income levels, all races, and all ethnic groups. Recruiting participants from nontraditional settings, such as workforce training programs, English-as-a-second-language programs, GED workshops, and community colleges, may be good places to find individuals whose voices have not been heard on this issue.
4. The media are the best sources of public advertising. Some public television stations and newspapers cover forums. Some newspapers have published issues in brief or issue maps which can be found in the “Engage” portion of wwww.alcoholfreechildren.org. Citizens can also write letters to the editor.
5.  Chambers of Commerce and members of the business community have been valuable assets in community enhancement projects. 

The second thing to remember is that there are prepared documents to help you.  The documents and resources listed below can help you make choices about this question:  How could our community prevent and reduce drinking by children aged 9-15?    They include:

• A sixteen-page discussion guide titled, "Childhood Drinking:  How Can We Prevent and Reduce the Number of Children Drinking Alcohol?"
• An eight-page guide to holding a conversation using the discussion guide
• A participant questionnaire for use  post-discussion
• A four-page "issue map" that outlines possible solutions for each of three options presented--to be used as a participant handout
• A link to a video hosted on U-Tube that introduces the three options--to be used as an introduction to the discussion
• State Data on Childhood Drinking Including Data on the Number of Children Who Drink Before Age 13

 

 Related Links to Videos on U-Tube about Childhood Drinking

• Lisa's Story
• David's Story

Sir Liam Donaldson on drinking in childhood - a short clip about the issue in Great Britain

Longer-Lasting Options To Treat Drug Addiction

New treatments for addiction to heroin or narcotic painkillers promise longer-lasting relief that may remove some day-to-day uncertainty of care: A once-a-month shot is now approved and a six-month implant is in the final testing phase.

The main treatment options have long been once-a-day medications — controversial methadone or a tablet named buprenorphine — that act as substitutes for the original drug, to suppress withdrawal and craving without the high.

Skipping a dose risks a relapse, but summoning the daily willpower to stick with treatment is "a formidable task," says National Institute on Drug Abuse director Dr. Nora Volkow.

Last week, the Food and Drug Administration approved the monthly shot Vivitrol for long-term treatment of opioid addiction — to heroin or such painkillers as morphine, Oxycontin and Vicodin.

Vivitrol works differently than methadone or buprenorphine: It blocks the high if a recovering addict slips up, and it's not addictive.

Scientists had tried a daily version of Vivitrol's ingredient, naltrextone, years ago, but too many patients skipped pills. So Alkermes Inc. created the longer-lasting version first for alcoholism in 2006, and now opioid addiction. In a study of 250 opioid addicts in Russia, more than half of Vivitrol recipients stuck with therapy for the six-month trial. Better, 36 percent stayed completely drug-free, compared with 23 percent who received dummy shots.

Next in the pipeline: A matchstick-size implant that for six months at a time slowly oozes a low dose of buprenorphine into the bloodstream, to keep cravings tamped down. A large study published last week deemed the implant, called Probuphine, promising — just over a third of those patients, too, tested drug-free. Ongoing research partly funded by the government should show next spring if it's ready for FDA evaluation.

Which approach will work best for which patient? Scientists don't know yet; there are pros and cons to daily and long-lasting versions. Early next year, NIDA will directly compare once-a-month Vivitrol to once-a-day buprenorphine and behavioral therapy alone to help tell.

But longer-lasting options promise to help keep patients on track longer.

"Opioid addicts are notoriously bad at complying with their medication. They like to take drug holidays. They like to party on the weekend," says Dr. Katherine Beebe of Titan Pharmaceuticals, which is developing the Probuphine implant.

And long-acting options also may help make substance abuse treatment more a part of mainstream medicine.

"To have these medications work effectively, you need to stay on them for long periods of time," says Dr. Patrick O'Connor of Yale University School of Medicine.

"We are really struggling to get the public and physicians to think of this more like a standard chronic disease — like diabetes, like cancer, like chronic lung disease — and not apply a special stigma to it."

About 800,000 people in the U.S. are addicted to heroin, and another 1.8 million either abuse or are dependent on opioid painkillers, Volkow says.

After initial detox, how to choose among long-term treatments?

Methadone is the cheapest but requires daily visits to a public clinic, many of which have waiting lists. Still, methadone may be the most potent choice for people who have abused heroin for many years, the hardest-to-treat patients, Volkow says.

Daily buprenorphine has increased access to care in recent years, because certain specially certified physicians can prescribe a month's supply of the pills at a time, for several hundred dollars.

Both methadone and buprenorphine require monitoring because they, too, can be abused, and some treatment programs won't use them because "their perception is you're changing one drug for another," says Volkow.

Only about 45,000 people have used Vivitrol since its approval for alcoholism in 2006; the new approval paves the way for insurance coverage of the $1,100 shot for opioid addiction, too. It occasionally causes serious side effects such as liver damage or injection-site reactions. Also, Volkow says it won't work for people who need addiction care and pain relief at the same time — they'll still need buprenorphine.

But Volkow expects Vivitrol will attract painkiller addicts who'd never consider other options, plus people struggling with daily therapy.

T.J. Voller of Westborough, Mass., became addicted to Oxycontin after an injury at 23 and moved on to heroin. Two tries of buprenorphine worked only briefly.

"If I didn't want to take it and wanted to get high, there was nothing to stop me," explains Voller, 29. He's been on Vivitrol for nearly a year and is back in college. "I get an injection once a month and I don't have to worry. I'm not saying I don't have my bad days, but they're much more manageable."