Red Bull's New Cola: A Kick from Cocaine?

http://www.time.com/time/world/article/0,8599,1900849,00.html

Monday, May. 25, 2009

Red Bull's New Cola: A Kick from Cocaine?

By Jean Friedman-Rudovsky
Time Magazine


About a year ago, the makers of Red Bull, the famous caffeine-loaded energy drink, decided to come out with a soda, unsurprisingly named Red Bull Cola. The shared name implied the same big kick. But could the cola's boost — supposedly "100% natural" — come from something else? Officials in Germany worry that they've found the answer — cocaine. And now they have prohibited the soda's sale in six states across the country and may recommend a nation-wide ban.

"The [Health Institute in the state of North Rhine Westphalia] examined Red Bull Cola in an elaborate chemical process and found traces of cocaine," Bernhard Kuehnle, head of the food safety department at Germany's federal ministry for consumer protection, told the German press on Sunday. According to this analysis, the 0.13 micrograms of cocaine per can of the drink does not pose a serious health threat — you'd have to drink 12,000 L of Red Bull Cola for negative effects to be felt — but it was enough to cause concern. Kuehnle's agency is due to give its final verdict on Wednesday when experts publish their report. (See pictures of America's cannabis culture.)

Red Bull has always been upfront about the recipe for its new cola. Its website boasts colorful pictures of coca, cardamom and Kola nuts, along with other key "natural" ingredients. The company insists, however, that coca leaves are used as a flavoring agent only after removing the illegal cocaine alkaloid. "De-cocainized extract of coca leaf is used worldwide in foods as a natural flavoring," said a Red Bull spokesman in response to the German government's announcement. Though the cocaine alkaloid is one of 10 alkaloids in coca leaves and represents only 0.8% of the chemical makeup of the plant, it's removal is mandated by international antinarcotics agencies when used outside the Andean region. (Check out a story on how Bolivia is preaching the virtues of coca culture.)

Meanwhile, in Bolivia, halfway around the world and smack in the middle of the Andes, the controversy is causing chuckles. Coca is a fundamental part of Andean culture and for years, Bolivians have tried to get the world to understand that the leaf is not a drug if it's not put through the extensive chemical process that yields cocaine. Left-wing President Evo Morales, a coca-grower himself, has made coca validation a personal quest, chewing leaves in front of world leaders and press cameras during his travels. "Let's say [Red Bull Cola] doesn't take out the cocaine alkaloid. Have any of those millions of people across the world who have drunk that soda ever gotten sick or felt drugged?" asks Dionicio Nunez, a coca-growers' leader from the Yungas region. "We've always known that coca isn't harmful. Now maybe others will realize it too."

In Germany, the Red Bull spokesman insisted that his company's product, along with others containing the coca-leaf extract are considered safe in Europe and the U.S. And already, some experts have come to Red Bull's defense. "There is no scientific basis for this ban on Red Bull Cola because the levels of cocaine found are so small," Fritz Soergel, the head of the Institute for Biomedical and Pharmaceutical Research in the city of Nuremberg, tells TIME. "And it's not even cocaine itself. According to the tests we carried out, it's a nonactive degradation product with no effect on the body. If you start examining lots of other drinks and food so carefully, you'd find a lot of surprising things," he says. (Read about the anti-Red Bull: a drink that can calm you down.)

Coca leaves, of course, have a long record in modern soda-pop history. Most prominently, there was Coca-Cola whose original 19th century formula used unaltered coca leaves. In the early 1900s the company said it would only use "spent," or decocainized leaves, though the company refuses to confirm whether leaves in any form are still used.

But the problem is when it comes to coca and cocaine, it's not just a health concern, but a legal one. Since 1961, trade of coca outside the Andean region — where people have chewed or brewed coca in tea to stave off hunger and exhaustion for centuries — has been prohibited unless the cocaine alkaloid is removed. Few companies in the world have authorization to trade in the leaf and most are pharmaceutical companies that perform this decocainizing process. The most prominent is New Jersey-based Stepan Chemical Company which has been reported to supply Coca-Cola with its narcotic-free derivative.

But no one knows where Red Bull Cola's coca leaves come from or where they are processed. Red Bull did not respond to immediate requests for comment and Rauch Trading AG, the Austria-based food company that actually manufactures Red Bull Cola was quick to tell TIME that they are not allowed to speak about the product. Meanwhile, Bolivia, which has lots of coca leaves to sell, is getting a kick out of the fact Red Bull Cola admits to using coca in any form (since Coca-Cola evades the question). Ironically, the drink is not actually available yet in Bolivia. But, the locals say, this is a great opportunity to show that coca isn't harmful — with or without the cocaine alkaloid.

Alcohol Tax Calculator

Alcohol Tax Calculator

(From Join Together) 

This new tool from Marin Institute can estimate new annual revenue from an alcohol tax or fee increase in your state.

The program instantly estimates additional annual revenues, based on a variety of factors specific to that particular jurisdiction, after an new tax amount (nickel or dime a drink, for example) is entered for beer, wine or spirits (or any combination).

http://www.marininstitute.org/site/index.php?Itemid=281

Publication Year: 2009

Publisher

Marin Institute
24 Belvedere Street
San Rafael, CA 94901
Phone: 415-456-5692
Website: http://www.marininstitute.org/
Email: info@marininstitute.org

Boost Treatment Access to Save Money, Improve Public Safety: Report

(http://www.justicepolicy.org/content-hmID=1817&smID=1571.htm#051909) New Reports Highlight Economic Benefits of Alternatives to Incarceration Research briefs on adult and juvenile justice outline ways for states to save millions

News Summary from Join Together 

A pair of new studies from the Justice Policy Institute (JPI) conclude that states can cut prison costs and improve long-term economic productivity by investing in addiction treatment for offenders and improving parole and probation practices.

"There's no magic formula for saving money and protecting public safety," said Tracy Velázquez, executive director of JPI. "Rather, policymakers can use the tools we already have and reduce correctional populations through incremental changes based on existing, evidence-based strategies."

States spend about $5.7 billion annually incarcerating (mostly nonviolent) youth offenders, but most could be safety managed in alternative community settings that would also reduce recidivism by up to 22 percent, according to the JPI report, The Costs of Confinement: Why Good Juvenile Justice Policies Make Good Fiscal Sense.

Investing in alternatives to incarcerating youth can yield up to $13 in benefits for every dollar spent, the study found.

A second report, Pruning Prisons: How Cutting Corrections Can Save Money and Protect Public Safety, finds that investing in addiction treatment for adult offenders could save states $18 for every dollar they spend. Other reform steps recommended by JPI include shifting 10 percent of the prison population into the parole system and adjusting parole support and services so fewer offenders return to prison for parole violations.

JPI's recommendations included:

• States and the federal government should reexamine policies that drive increases in incarceration, such as recommitment for technical violations of parole conditions, and incarceration for low-level drug offenses and many nonviolent offenses. Non-incarcerative, community-based alternatives should be explored.
  
• States and the federal government should implement policies that can safely increase releases from prison through parole and other community-based programs.
  
• As closing prisons realizes the largest financial savings, policymakers should scale their reforms to enable the closure of a facility or, at a minimum, a wing or other discrete portion of a facility.
  
• To achieve long-term public safety gains, money saved on incarceration should be invested in community-based services that improve both public safety and the life outcomes of individuals, and in social institutions that build strong communities, including education, employment training, housing, and treatment.
  
• Incentivize counties to send fewer youth to residential care facilities by shifting the fiscal architecture of the state juvenile justice system to reward increased utilization of community-based options.
  
• Invest in intermediate interventions, not secure facilities that don't improve public safety and interfere with youth development and the chances of future success.
  
• Invest in proven approaches to reduce crime and recidivism among young people.
  
• Fund evaluations of effective programs and policies in juvenile justice, and support the development of new and different approaches to reduce delinquency and recidivism among young people. 

• CONTACT: LaWanda Johnson (202) 558-7974 x308 Cell: (202) 320-1029

MedEdPORTAL: Cultural Sensitivity in OB/GYN

(http://services.aamc.org/30/mededportal/servlet/dynamic/segment/mededportal/?id=4848)

You may need to register (for free) with MedEdPORTAL to access this material. To browse any of MedEdPORTAL's many fine CME resources, try: http://services.aamc.org/30/mededportal/servlet/segment/mededportal/find_resources/browse/ Title: Cultural Sensitivity in OB/GYN: the Ultimate Patient-Centered Care
MedEdPORTAL ID#: 1658
Version: 1
Resource Type: Lecture Presentation
Description: This is a PowerPoint presentation with accompanying speaker notes suitable for presentation to healthcare learners at nearly any level of training: students, residents, fellows and faculty. The resource is designed to be used in an interactive style with learner participation. Practical suggestions are included to assist in a total assessment of the patient with emphasis on language barriers and cultural barriers. Varied simple clinical vignettes allow the learners to explore how cultural differences can impact care in the field of obstetrics and gynecology. Culturally sensitive care allows the patient to more fully partner with the provider in achieving better health. The resource stresses the need for cultural sensitivity versus cultural stereotyping.
Author Institution: University of Iowa Roy J. and Lucille A. Carver COM
Primary Author:
Marygrace Elson, MD University of Iowa Roy J. and Lucille A. Carver COM Univ Iowa Dept Ob/Gyn 51220 PFP, 200 Hawkins Drive Iowa City , IA 52242-1080 USA 319-356-3053 marygrace-elson@uiowa.edu
Resource File(s):
Download File: MEP_1658_1 / 2426.0 KB This resource is comprised of multiple files that have been zipped into a single file for quick and easy download. Click on the above link to download the resource as a ".zip" file. To extract the ".zip" file you must have decompressing software installed on your computer which is available for free from any of the following sites: jZip - www.jzip.com WinZip - www.winzip.com Stuffit - my.smithmicro.com/win/stuffit
Additional Resource File Information:
1 .zip file containing: 1. Cultural_Sensitivity.ppt 2. Speaker_Notes.pdf 3. Copyright_License.pdf
AAMC Hot Topics:
Medicine: Communication Skills Medicine: Cultural Diversity
Content Last Updated:
02/13/2009
Specialty/Discipline:
Medicine: Obstetrics and Gynecology
Educational Objectives:
1.) To identify cultural barrers which lead to health care disparities. 2.) To determine when and how to use an interpreter. 3.) To apply principles of cross-cultural communication to every patient encounter. 4.) To appraise and respond to cultural cues in the clinical setting.
Resource Keyword/Symptom:
Cultural Competency Cultural Sensitivity Culturally-Sensitive Care Patient-Centered Care Language Barrier Cultural Competency (MeSH) Cultural Diversity (MeSH) Patient-Centered Care (MeSH) Communication Barriers (MeSH) Stereotyping (MeSH)
Accreditation Council for Graduate Medical Education (ACGME) Competencies Addressed:
Patient Care Interpersonal and Communication Skills
Intended Learner Audience:
3rd Year Medical/Dental Students 4th Year Medical/Dental Students Medical Fellows Medical/Dental Residents Continuing Medical/Dental Education (CME) for Faculty Self Learning
Intended Faculty Audience:
Clinical Science Faculty Clerkship Director / Clinical Science Course Director
Effectiveness and Significance of Publication:
The resource has been utilized eight times per year for the last two years as part of the OB-GYN clinical clerkship at University of Iowa Carver College of Medicine. During this time it has undergone significant revision based on learner feedback; simple clinical vignettes were added. Learners have indicated that this was a topic which otherwise did not receive much emphasis in the course of the M3 year. A recent learner recommended, "cultural competencies lecture at the beginning, not the end of the clerkship, would have been more beneficial."
Special Implementation Requirements or Guidelines:
Computer and Projector for PowerPoint This educational resource is best-suited to an interactive didactic session. I have utilized this presentation both for smaller (<20)>
Lessons Learned:
Resource works best in smaller interactive sessions but can be used with a larger group.
Publications, Presentations, and/or Citations For This Publication:
None.
Sponsorship (Funding Source):
None.
Yes
All Parties Content Is Associated With:
No copyright notices found for images imported from web. Microsoft Clipart acceptable use as used for "personal,noncommercial use." http://www.microsoft.com/about/legal/permissions/default.mspx
Citation Formats:
NLM:
Elson M , Cultural Sensitivity in OB/GYN: the Ultimate Patient-Centered Care. MedEdPORTAL; 2009. Available from: http://services.aamc.org/30/mededportal/servlet/s/segment/mededportal/?subid=1658
APA:
Elson, M., (2009). Cultural Sensitivity in OB/GYN: the Ultimate Patient-Centered Care. MedEdPORTAL: http://services.aamc.org/30/mededportal/servlet/s/segment/mededportal/?subid=1658

Vitamin D and Other New/Complementary Therapies for Pain

(http://pain-topics.org=GREAT Pain Website)
Alternative & Complementary Therapy

Vitamin D: A Champion of Pain Relief

By: Stewart B. Leavitt, MA, PhD, Pain Treatment Topics, June 2008.

Download PDF: http://pain-topics.org/pdf/vitamind-brochure.pdf (200 KB, 6-pages)

Chronic pain – often involving muscles, bones, and joints – is a common problem leading patients to seek medical care. Overcoming these problems may be as simple, safe, and inexpensive as an extra dose of vitamin D each day.

This 6-page brochure explains in easy-to-understand language what vitamin D is and how it works. In also describes how inadequate vitamin D intake may play a role in aches and pains, as well as the benefits of vitamin D supplementation for relieving these symptoms.

Pain Control — How to Use Imagery

From: National Cancer Institute; January 2008; 2 pages.

Available in HTML online at: http://www.cancer.gov/cancertopics/paincontrol/page14.

Imagery can be a useful technique to achieve more effective pain management. Complementary therapies can be added to pharmacotherapy and oftentimes reduce the medication dosage needed to adequately manage pain. This report is part of an NCI booklet on cancer pain management and includes instructions in the use of imagery and breathing exercises to achieve relaxation. Access checked November 6, 2008.

Copies of the complete booklet, entitled 'Pain Control: Support for People With Cancer', is available at no charge from NCI and may be ordered by telephoning 800-422-6237. Access checked November 5, 2008.

Meditation for Health Purposes

From: National Center for Complementary and Alternative Medicine (NCCAM); reviewed 2007; 6 pages.

Website PDF available at: http://nccam.nih.gov/health/meditation/meditation.pdf

Also available online at: http://nccam.nih.gov/health/meditation/.

Studies have shown that meditation can promote pain relief and reduce other symptoms that can aggravate pain, such as anxiety, depression, and insomnia. Several types of meditation, including the main elements of all meditative practices, are discussed. A brief look at the theories on how meditation affects the body and the specific topics of recent NCCAM scientific studies are included. Access checked November 3, 2008.

Selecting a CAM Practitioner

From: National Center for Complementary and Alternative Medicine (NCCAM); revised 2007; 6 pages.

PDF available here for download: http://nccam.nih.gov/health/decisions/D346.pdf

Also available online at: http://nccam.nih.gov/health/decisions/practitioner.htm.

The selection of a complementary or alternative medicine (CAM) practitioner can be confusing and intimidating. This fact sheet offers some key considerations for the patient who is interested in finding and selecting an appropriate CAM therapist. Guidance for the patient regarding the kinds of questions to ask during the initial visit are included. Access checked January 12, 2009.

Psychology and Pediatric Pain

From: National Pain Foundation; revised 2009; 3 pages.

See HTML article online at: http://www.nationalpainfoundation.org/articles/855/psychology-and-pediatric-pain

Psychological therapy can be an integral component in the treatment of chronic pain in children. This article explains that pain is a physical and psychological experience so it can be beneficial to evaluate the child's feelings related to the pain. Feelings of frustration, anger, and anxiety can exacerbate chronic pain and compound the challenges of treatment. This summary of the role psychology can play in a child's pain is one part of the NPF's section entitled "Children and Pain"; see also two focused sections (left-hand column) on psychology in headaches and complex regional pain syndrome. Access checked May 16, 2009.

Using Complementary Therapy

From: National Pain Foundation; revised 2009; 5 pages.

See HTML article online at: http://www.nationalpainfoundation.org/articles/89/using-complementary-therapy

The use of complementary therapy continues to increase in patients experiencing chronic pain. A complementary approach is frequently used in combination with pharmacotherapy to enhance pain relief while reducing the overall consumption of drugs. This article provides a basic description of 11 different types of complementary therapy and would be a helpful handout for a patient who is interested in learning more about complementary treatment options. In addition to recommendations on choosing a practitioner, the article explains the rationale behind using the following types of therapy: acupuncture, biofeedback, chiropractic manipulation, guided imagery, herbal medicine, hypnosis, naturopathic medicine, relaxation techniques, and yoga. Access checked May 16, 2009.

Get the Facts: Acupuncture

From: National Center for Complementary and Alternative Medicine (NCCAM); revised December 2004; 8 pages.

Website PDF available at: http://nccam.nih.gov/health/acupuncture/acupuncture.pdf

Also available online at: http://nccam.nih.gov/health/acupuncture/.

This data sheet from NCCAM provides an overview of acupuncture, including a brief history and a statement about the growth of the practice in the United States. Evidence of the safety and effectiveness of acupuncture is explained and theories on why it can be effective for pain management are proposed. Tips for finding a licensed practitioner and a glossary of terms used in the practice are included. Access checked November 6, 2008.

What You Should Know About Herbal and Dietary Supplement Use and Anesthesia

From: American Society of Anesthesiologists; 2003; 2 pages.

Website PDF available at: http://www.asahq.org/patientEducation/herbPatient.pdf

Based on the fact that nearly one third of surgical patients use at least one herbal supplement regularly, the American Society of Anesthesiologists created a brochure to communicate the message that failure to disclose such information before surgery can be have dangerous consequences. Oftentimes, patients unknowingly consider herbs and supplements as natural and, therefore, safe. While the brochure provides specific data on the potential side effects or interactions for 15 supplements, patients are also urged to inform surgeons and anesthesiologists of any vitamin, nutritional supplement, or herbal medicine use before surgery. Access checked November 6, 2008.

Relaxation Exercise

From: StopPain.org, Beth Israel University Hospital; undated; 15-minute audio with slides

Play audio-visual exercise at: http://www.healingchronicpain.org/content/relax/default.asp.

Relaxation exercises have been shown to reduce pain, anxiety, and depression. This audio-visual program uses visualization and breathing as the basis for relaxation and offers basic instruction for patients who are new to this type of relaxation exercise. The visualization component offers options for three different slide formats: sky, water, and trees. The slides change continually as the speaker gently instructs the user on techniques for focusing on mental images that soothe and comfort and, therefore, relax and aid the release of physical discomforts. This is a useful tool that is instructive and one that can be used repeatedly. Access checked November 6, 2008.

Check Here Before Buying Medicines Online

Check Here Before Buying Medicines Online

The Internet can be a hazardous place to buy medicines unless the source is legitimate and follows high standards for product quality and delivery. The two free websites below specialize in evaluating Internet Pharmacy sites and providing helpful information to consumers.

(Many Thanks to Stu Leavitt for this information)

Online Pharmacies You Can Trust

From: LegitScript; updated often.

Go to: http://www.legitscript.com/
(Enter pharmacy name in search box, or click on “Pharmacies” tab for listings.)

LegitScript is a private organization whose mission is to assist consumers and businesses in determining which online pharmacies operate safely and in compliance with Federal and state laws and regulations, as well as with accepted medical standards and ethics. LegitScript Internet-pharmacy verification standards have been recognized by the National Association of Boards of Pharmacy (NABP). This website allows consumers to find the right online pharmacy for them, based on factors such as the state where the online pharmacy is authorized to deliver prescription drugs, pharmacy specialty, method of payment, and other factors.

Safely Buying Medicine Online

From: NABP (National Association of Boards of Pharmacy); updated often.

Go to: http://www.nabp.net/IP/intro.asp
(Click tab on left side: Internet Pharmacies, Buying Medicine Online.)

NABP (National Association of Boards of Pharmacy) is an independent international association assisting its member boards in developing, implementing, and enforcing uniform pharmacy standards for the purpose of protecting the public health. The organization has reviewed numerous websites selling prescription medicines and has identified those that are accredited through its Verified Internet Pharmacy Practice Sites™ (VIPPS®) or are not recommended because they are out of compliance with state and federal laws or NABP patient safety and pharmacy practice standards.

Screening and Brief Intervention: Making a Public Health Difference

(http://www.jointogether.org/keyissues/sbi/) Screening and Brief Intervention: Making a Public Health Difference

Join Together published a policy report encouraging the increased use of screening and brief interventions. This policy report serves as a primer on screening and brief interventions (SBI) issues, covers barriers to expanded utilization, and recommends ways to boost understanding and usage of this important public health tool.

The report recommends the following for Health Care Settings:

• Don't expect physicians to bear the sole responsibility for widespread public health implementation of SBI.
• Involve specialty health providers to share the responsibility for providing SBI services.
• Include SBI as part of medical school curriculum and residency training.
• Use screening tools that emphasize ease of use, and integrate screening for alcohol and drug use with other routine preventive screenings.

Additionally the report recommends: Encouraging professional associations to endorse SBI as routine health care practice; Expanding SBI beyond the health care system; Repealing state insurance laws that discourage screening and brief intervention services; and Using direct to consumer marketing to raise the demand for screening and brief interventions.

Order a copy of the report or download it now using the link below.

http://www.jointogether.org/jump.jsp?path=/aboutus/ourpublications/pdf/sbi-report.pdf

2.0 MB

Publication Year: 2008

Publisher

Join Together
The National Center on Addiction and Substance Abuse at Columbia University
715 Albany St, 580 -- 3rd Floor
Boston, ma 02118
Phone: 617-437-1500
Website: http://www.jointogether.org
Email: info@jointogether.org

Mental illness may up risk of postpartum suicide

Mental illness may up risk of postpartum suicide (http://www.reuters.com/article/healthNews/idUSCOL86012220080818)

Mon Aug 18, 2008 4:21pm EDT

By Amy Norton

NEW YORK (Reuters Health) - New mothers with a history of depression or other psychiatric disorders appear more likely than other women to attempt suicide soon after giving birth, a new study suggests.

Researchers found that among nearly 1,800 women who recently gave birth, those with a history of a psychiatric disorder were 27 times more likely to attempt suicide in the year after having their baby.

Similarly, women with a history of substance abuse had a six-fold increase in their risk of attempted suicide.

Postpartum suicide is rare, but the new findings point to a group of women who may be at greatest risk, the researchers note in the American Journal of Obstetrics & Gynecology.

Women, their families and their doctors should be aware that past psychiatric disorders and substance abuse are risk factors for postpartum suicide, lead researcher Dr. Katherine A. Comtois, of the University of Washington School of Medicine in Seattle, told Reuters Health.

The findings are based on hospital records from women who gave birth in Washington State between 1992 and 2001. The researchers identified 355 women who were hospitalized for a suicide attempt in the year after giving birth; they matched each of these women with another four who had given birth in the same year but did not attempt suicide.

Overall, Comtois and her colleagues found, the risk of postpartum suicide was markedly higher among women who'd been hospitalized with a psychiatric disorder, substance abuse problem or both 5 years before giving birth.

Such diagnoses are "clearly important risk factors" of which families and medical providers should be aware, Comtois said.

The American College of Obstetricians and Gynecologists recently recommended that women be screened for depression and other "psychosocial risk factors" during prenatal care, Comtois and her colleagues note in the report.

"Future studies," they write, "should evaluate the effectiveness of screening for psychiatric and substance use disorders on decreasing adverse outcomes such as suicide attempts during the postpartum period."

SOURCE: American Journal of Obstetrics & Gynecology, August 2008.

Spontaneous preterm birth and small for gestational age infants in women who stop smoking early in pregnancy: prospective cohort study

(http://www.bmj.com/cgi/content/abstract/338/mar26_2/b1081) Spontaneous preterm birth and small for gestational age infants in women who stop smoking early in pregnancy: prospective cohort study

Lesley M E McCowan, associate professor of obstetrics and gynaecology¹, Gustaaf A Dekker, professor of obstetrics and gynaecology⁶, Eliza Chan, research fellow¹, Alistair Stewart, statistician², Lucy C Chappell, senior lecturer in maternal and fetal medicine⁴, Misty Hunter, medical student¹, Rona Moss-Morris, professor of health psychology⁵, Robyn A North, professor in obstetric medicine³, On behalf of the SCOPE consortium

¹ Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, School of Population Health, University of Auckland, Auckland, New Zealand, ² Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, School of Population Health, University of Auckland, Auckland, New Zealand, ³ Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, University of Adelaide, Australia, ⁴ Division of Reproduction and Endocrinology, King’s College London, ⁵ School of Psychology, University of Southampton, ⁶ Women and Children’s Division, Lyell McEwin Hospital, University of Adelaide, Adelaide, South Australia

Correspondence to: L M E McCowan, Department of Obstetrics and Gynaecology l.mccowan@auckland.ac.nz

Objectives To compare pregnancy outcomes between women who stopped smoking in early pregnancy and those who either did not smoke in pregnancy or continued to smoke.

Design Prospective cohort study.

Setting Auckland, New Zealand and Adelaide, Australia.

Participants 2504 nulliparous women participating in the Screening for Pregnancy Endpoints (SCOPE) study grouped by maternal smoking status at 15 (±1) week’s gestation.

Main outcome measures Spontaneous preterm birth and small for gestational age infants (birth weight <10th> We compared odds of these outcomes between stopped smokers and non-smokers, and between current smokers and stopped smokers, using logistic regression, adjusting for demographic and clinical risk factors.

Results 80% (n=1992) of women were non-smokers, 10% (n=261) had stopped smoking, and 10% (n=251) were current smokers. We noted no differences in rates of spontaneous preterm birth (4%, n=88 v 4%, n=10; adjusted odds ratio 1.03, 95% confidence interval l0.49 to 2.18; P=0.66) or small for gestational age infants (10%, n=195 v 10%, n=27; 1.06, 0.67 to 1.68; P=0.8) between non-smokers and stopped smokers. Current smokers had higher rates of spontaneous preterm birth (10%, n=25 v 4%, n=10; 3.21, 1.42 to 7.23; P=0.006) and small for gestational age infants (17%, n=42 v 10%, n=27; 1.76, 1.03 to 3.02; P=0.03) than stopped smokers.

Conclusion In women who stopped smoking before 15 weeks’ gestation, rates of spontaneous preterm birth and small for gestational age infants did not differ from those in non-smokers, indicating that these severe adverse effects of smoking may be reversible if smoking is stopped early in pregnancy.

Conclusion and policy implications
Data from this large prospective cohort study of nulliparous women have shown that stopping smoking before 15 weeks’ gestation is associated with rates of spontaneous preterm birth and small for gestational age infants similar to those in women who do not smoke in pregnancy. Maternity care providers should strive to assist pregnant women who smoke to stop early in pregnancy, emphasising the major health benefits if they cease to smoke before 15 weeks’ gestation.

What is already known on this topic Smoking is the single most modifiable risk factor for adverse pregnancy outcomes in developed countries Stopping smoking in pregnancy increases birth weight and reduces rates of all preterm birth The gestation by which smoking must stop to reverse effects of smoking on spontaneous preterm births and small for gestational age infants is not known What this paper adds Stopping smoking early in pregnancy, before 15 weeks’ gestation, results in rates of spontaneous preterm births and small for gestational age infants similar to those in non-smokers Women who continue to smoke at 15 weeks’ gestation are more likely than those who stop smoking to have spontaneous preterm birth Pregnant women should be offered support and interventions to help them stop smoking early in pregnancy

Cite this as: BMJ 2009;338:b1081

© McCowan et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
http://creativecommons.org/licenses/by-nc/2.0/

Published 26 March 2009, doi:10.1136/bmj.b1081
Cite this as: BMJ 2009;338:b1081

Teens Who Drink When Depressed at Higher Risk of Suicide (http://www.jahonline.org/article/S1054-139X%2808%2900337-6/abstract)

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http://www.jointogether.org/news/research/summaries/2009/teens-who-drink-when.html

http://www.jahonline.org/article/S1054-139X(08)00337-6/abstract

Volume 44, Issue 4, Pages 335-341 (April 2009)

6 of 19
Adolescent Alcohol Use, Suicidal Ideation, and Suicide Attempts

Elizabeth A. Schilling, Ph.D.ab, Robert H. Aseltine Jr., Ph.D.ab, Jaime L. Glanovsky, M.S.bc, Amy Jamesab, Douglas Jacobs, M.D.d

Received 25 March 2008; accepted 7 August 2008. published online 29 October 2008.

Abstract
Purpose
To examine the association between self-reported alcohol use and suicide attempts among adolescents who did and did not report suicidal ideation during the past year.

Methods
Screening data from 31,953 students attending schools in the United States that implemented the Signs of Suicide (SOS) program in 2001–2002 were used in this analysis. Two types of alcohol use were investigated: heavy episodic drinking, and drinking while down. Self-reported suicide attempts were regressed on suicidal ideation and both measures of alcohol use, controlling for participants’ levels of depressive symptoms, and demographic characteristics.

Results
Logistic regression analyses indicated that both drinking while down and heavy episodic drinking were significantly associated with self-reported suicide attempts. Analyses examining the conditional association of alcohol use and suicidal ideation with self-reported suicide attempts revealed that drinking while down was associated with significantly greater risk of suicide attempt among those not reporting suicidal ideation in the past year. Heavy episodic drinking was associated with increased risk of suicide attempt equally among those who did and did not report suicidal ideation.

Conclusions
This study identified the use of alcohol while sad or depressed as a marker for suicidal behavior in adolescents who did not report ideating prior to an attempt, and hence, may not be detected by current strategies for assessing suicide risk. Findings from this study should provide further impetus for alcohol screening among clinicians beyond that motivated by concerns about alcohol and substance use.

Keywords: Suicide, Suicide attempts, Alcohol, Adolescent, Ideation, Sad, Blue, Down, Binge, Heavy Episodic drinking, Drinking

a Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, Connecticut

b Institute for Public Health Research, University of Connecticut Health Center, East Hartford, Connecticut

c Department of Statistics, University of Connecticut, Storrs, Connecticut

d Screening for Mental Health, Inc., and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts

Address correspondence to: Elizabeth A. Schilling, Ph.D. or Robert H. Aseltine, Jr., Ph.D., Institute for Public Health Research, University of Connecticut Health Center, 99 Ash Street, MC 7160, East Hartford, CT 06108.

PII: S1054-139X(08)00337-6

http://download.journals.elsevierhealth.com/pdfs/journals/1054-139X/PIIS1054139X08003376.pdf

Smoking Impedes Brain's Recovery from Alcohol Damage

Smoking Impedes Brain's Recovery from Alcohol Damage.htm

http://www.jointogether.org/news/research/summaries/2009/smoking-impedes-brains.html

http://www3.interscience.wiley.com/journal/122371192/abstract?CRETRY=1&SRETRY=0

The Impact of Chronic Cigarette Smoking on Recovery From Cortical Gray Matter Perfusion Deficits in Alcohol Dependence: Longitudinal Arterial Spin Labeling MRI

Anderson Mon, Timothy C. Durazzo, Stefan Gazdzinski, and Dieter J. Meyerhoff
From the Department of Radiology, University of California (AM, TCD, DJM), Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center (AM, TCD, SG, DJM), San Francisco, California.

Correspondence to Reprint requests: Dr. Anderson Mon, Center for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, Building 13, Mail Stop 114 M, 4150 Clement Street, San Francisco, CA 94121; Fax: 001-415-668-2864; E-mail: Anderson.Mon@ucsf.edu

Copyright © 2009 Research Society on Alcoholism
KEYWORDS
Magnetic Resonance • Perfusion • Blood Flow • Smoking • Alcohol Use Disorder
ABSTRACT
Background: Neuroimaging studies reported cerebral perfusion abnormalities in individuals with alcohol use disorders. However, no longitudinal magnetic resonance imaging (MRI) studies of cerebral perfusion changes during abstinence from alcohol have been reported.

Methods: Arterial spin labeling MRI was used to evaluate cortical gray matter perfusion changes in short-term abstinent alcohol dependent individuals in treatment and to assess the impact of chronic cigarette smoking on perfusion changes during abstinence. Seventy-six patients were scanned at least once. Data from 19 non-smoking (17 males, 2 females) and 22 smoking (21 males, 1 female) patients scanned at 1 and 5 weeks of abstinence were used to assess perfusion changes over time. Twenty-eight age-equated healthy controls (25 males, 3 females) were scanned for cross-sectional comparison, 13 of them were scanned twice. Given the age range of the cohort (28 to 68 years), age was used as a covariate in the analyses. Mean perfusion was measured in voxels of at least 80% gray matter in the frontal and parietal lobes and related to neurocognitive and substance use measures.

Results: At 1 week of abstinence, frontal and parietal gray matter perfusion in smoking alcoholics was not significantly different from that in non-smoking alcoholics, but each group's perfusion values were significantly lower than in controls. After 5 weeks of abstinence, perfusion of frontal and parietal gray matter in non-smoking alcoholics was significantly higher than that at baseline. However, in smoking alcoholics, perfusion was not significantly different between the time-points in either region. The total number of cigarettes smoked per day was negatively correlated with frontal gray matter perfusion measured at 5 weeks of abstinence. Lobar perfusion measures did not correlate significantly with drinking severity or cognitive domain measures at either time-point.

Conclusion: Although cerebral perfusion in alcohol dependent individuals shows improvement with abstinence from alcohol, cigarette smoking appears to hinder perfusion improvement.

Received for publication September 23, 2008; accepted March 2, 2009.

Schwarzenegger Invites Debate on Marijuana De-criminalization In California

http://www.jointogether.org/news/headlines/inthenews/2009/schwarzenegger-lets-debate.html

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/05/05/MNO617F929.DTL

http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/05/06/MNO617F929.DTL
Governor says he's open to debate on legal pot
Wyatt Buchanan, Chronicle Staff Writer
Wednesday, May 6, 2009
(05-06) 04:00 PDT Sacramento - -- Gov. Arnold Schwarzenegger said Tuesday that the time is right to debate legalizing marijuana for recreational use in California.

The governor's comments were made as support grows nationwide for relaxing pot laws and only days after a poll found that for the first time a majority of California voters back legal marijuana. Also, a San Francisco legislator has proposed regulating and taxing marijuana to bring the state as much as $1.3 billion a year in extra revenue.

Schwarzenegger was cautious when answering a reporter's question Tuesday about whether the state should regulate and tax the substance, saying it is not time to go that far.

But, he said: "I think it's time for debate. I think all of those ideas of creating extra revenues - I'm always for an open debate on it."

The governor said California should look to the experiences of other nations around the world in relaxing laws on marijuana.

Assemblyman Tom Ammiano, D-San Francisco, has introduced a bill to regulate marijuana like alcohol, with people over 21 years old allowed to grow, buy, sell and possess cannabis - all of which are barred by federal law.

California voters in 1996 legalized marijuana for medical use with permission from a physician.
Ammiano said he was pleased the governor is "open-minded" on the issue and added that he was sure the two could "hash it out."

Under Ammiano's proposal, the state would impose a $50-an-ounce levy on sales of marijuana, which would boost state revenues by about $1.3 billion a year, according to an analysis by the State Board of Equalization. Betty Yee of San Francisco, who chairs the Board of Equalization, supports the measure.

"This has never just been about money," said Ammiano, who has long supported reforming marijuana laws. "It's also about the failure of the war on drugs and implementing a more enlightened policy. I've always anticipated that there could be a perfect storm of political will and public support, and obviously the federal policies are leaning more toward states' rights."

An ABC News/Washington Post poll last week found that 46 percent of Americans favored legalization of small amounts of pot for personal use, double the number who supported that a decade ago. A Field Poll also released last week found that 56 percent of California voters supported legalizing and taxing marijuana.

In March, U.S. Attorney General Eric Holder said the federal government would take a softer stance on medical marijuana dispensaries, with drug enforcement agents targeting only those who violate state and federal law. California is one of 13 states that allow marijuana use with a doctor's recommendation.

Many law enforcement organizations oppose changes in marijuana laws. The California Police Chiefs Association, in a report last month, concluded that marijuana dispensaries constitute "a clear violation of federal and state law; they invite more crime; and they compromise the health and welfare of law-abiding citizens."

But the head of that association said he, too, is open to a debate on legalizing pot.
"We keep walking around the 5,000-pound elephant in the room, which is should marijuana be legal?" said Bernard Melekian, president of the association and chief of police in Pasadena.

The Board of Equalization analysis predicts that legalization would drop the street value of marijuana by 50 percent and increase consumption by 40 percent.

Bruce Mirken, spokesman for the Marijuana Policy Project, which advocates legalization, said the governor's comments about marijuana are part of a "tectonic shift" in attitudes toward the issue.

"I think, frankly, the public is going to drag the politicians into doing what is right," he said.
Chronicle staff writer Matthew Yi contributed to this report. E-mail Wyatt Buchanan at wbuchanan@sfchronicle.com.
This article appeared on page A - 1 of the San Francisco Chronicle

'Wet' housing in Seattle-Report From Dr. Michael Clark

Subject: 'Wet' housing in Seattle

Folks may have already heard about this, but the results of Seattle's
experiment with 'wet' housing- housing that allows chronic alcoholic
residents to drink in their own rooms- have started to be published.
Basically, the city bought a building with rooms for 75 people, then
took a list of the worst homeless chronic alcoholics, and went right down the
list offering them housing at the Housing First site until the building
was full.

Of course it was attacked by all the usual suspects for the usual
reasons. That is encouraged drinking, was morally wrong, that it wouldn't work,
that it would be a problem to neighbors. None of this happened.

Rather alcohol consumption in these worst of the worst dropped from 15.7
drinks/day to 10.6 (several quit!). Median taxpayer cost (jail, detox,
ER visits, other medical costs, etc.) dropped from $4066/month to
$958/month after 1 year. It ended up saving Seattle taxpayers $4 million in the
first year of operation alone! And according to the folks I work with
in the Harborview ER, we just don't see them anymore (many used to be in
there weekly or more). Not bad for something virtually all the media
and drug warriors said was an obviously terrible idea!

http://www.desc.org/documents/DESC_1811_JAMA_info.pdf

http://jama.ama-assn.org/cgi/content/abstract/301/13/1349

http://seattletimes.nwsource.com/html/jerrylarge/2008969201_jdl02.html

http://www.seattlepi.com/opinion/346728_homelessed.html

Mike

------------------------------

----------------------------
Michael Clark M.D., Ph.D.
Assistant Professor
Dept. of Psychiatry and Behavioral Science
University of Washington
Harborview Medical Center, Box 359911
Seattle, WA 98104
Pager/Voice-Mail 206-541-9241
email: msclark@u.washington.edu
--------------------------------------------------------

"It is difficult to get a man to understand something when his salary
depends upon his not understanding it" -Upton Sinclair