Psychoactive drugs of misuse: rationalising the irrational
Lancet Volume 369, Issue 9566 , 24 March 2007-30 March 2007, Page 972http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-4N9XF65-7&_user=2052169&_coverDate=03%2F30%2F2007&_rdoc=7&_fmt=full&_orig=browse&_srch=doc-info(%23toc%234886%232007%23996300433%23646931%23FLA%23display%23Volume)&_cdi=4886&_sort=d&_docanchor=&_ct=38&_acct=C000046147&_version=1&_urlVersion=0&_userid=2052169&md5=428821527782ef2f08bd6e049eda9bb3CommentPsychoactive drugs of misuse: rationalising the irrationalWayne HallIdeally, policy responses to psychoactive drugs of misuse would take into account the variations in harm that each kind causes to users and the community. In today's Lancet, David Nutt and colleagues1 show that the UK classification of psychoactive drugs into three categories of harm (A, B, and C) is only modestly correlated with expert ratings of the harms caused. They also point out the obvious: the classification excludes the psychoactive drugs whose use causes the greatest harm—ie, alcohol and tobacco.2Nutt and colleagues asked UK experts in psychiatry, pharmacology, and addiction to rate drugs on three major dimensions of harm: physical health effects, potential for dependence, and social harms. The experts showed reasonable levels of agreement in their rankings. By contrast, their ratings were not well correlated with the UK classification, but the rank ordering was much the same as earlier rankings of drugs that took harms into\u003cbr\>The UK classification has been developed over nearly a century by small changing groups of experts. The information available to them on the harms that newer drugs cause has varied in quantity and quality, and, in the face of uncertainty, prudence has often led to drugs receiving the most risky classification, with limited opportunity to later revise these rankings.\u003cbr\>\u003cbr\>By contrast, Nutt and colleagues asked experts to compare the risks of various drugs (including alcohol and tobacco) on many dimensions of harm, gave the opportunity to revise ratings in the light of those of the group, and used statistics to derive overall rankings.\u003cbr\>\u003cbr\>Nonetheless, there remain major impediments to the adoption of policies that are better aligned with drug-related harms. Those who believe, for example, that legal penalties should be proportionate to the harm that drug use causes would argue that we should reduce penalties for use of the least harmful of the currently illicit drugs, among which cannabis would be the leading contender. The rankings also suggest the need for better regulation of the more harmful drugs that are currently legal (ie, tobacco and alcohol).\u003cbr\>\u003cbr\>The wealthy, well organised, powerful, and politically connected alcohol and tobacco industries will be able to resist policies that would more effectively reduce the harms that their products cause. Several millennia of human experience with alcohol, its pervasiveness in industrialised cultures, and the US experience with alcohol prohibition (1920–32) make it unlikely that any industrialised society will criminalise alcohol use. But that still leaves plenty of room for more effective use of taxation and regulatory controls to reduce alcohol-related harm.\u003cbr\>\u003cbr\>Populism favours tough policies towards illicit drugs such as cannabis. Psychoactive drugs (other than alcohol and tobacco) remain the last holdout of the most restrictive form of regulation—criminal prohibition—despite the enthusiastic embrace of market deregulation almost everywhere else. This situation could change if the USA embraced a free market regime for all psychoactive drugs. But as attractive as this approach may be to libertarians, it would not be good public-health policy. Allowing a free market for all currently illicit drugs would add substantially to the harms now caused by alcohol and tobacco.",1]);//-->account.3 and 4The UK classification has been developed over nearly a century by small changing groups of experts. The information available to them on the harms that newer drugs cause has varied in quantity and quality, and, in the face of uncertainty, prudence has often led to drugs receiving the most risky classification, with limited opportunity to later revise these rankings.By contrast, Nutt and colleagues asked experts to compare the risks of various drugs (including alcohol and tobacco) on many dimensions of harm, gave the opportunity to revise ratings in the light of those of the group, and used statistics to derive overall rankings.Nonetheless, there remain major impediments to the adoption of policies that are better aligned with drug-related harms. Those who believe, for example, that legal penalties should be proportionate to the harm that drug use causes would argue that we should reduce penalties for use of the least harmful of the currently illicit drugs, among which cannabis would be the leading contender. The rankings also suggest the need for better regulation of the more harmful drugs that are currently legal (ie, tobacco and alcohol).The wealthy, well organised, powerful, and politically connected alcohol and tobacco industries will be able to resist policies that would more effectively reduce the harms that their products cause. Several millennia of human experience with alcohol, its pervasiveness in industrialised cultures, and the US experience with alcohol prohibition (1920–32) make it unlikely that any industrialised society will criminalise alcohol use. But that still leaves plenty of room for more effective use of taxation and regulatory controls to reduce alcohol-related harm.Populism favours tough policies towards illicit drugs such as cannabis. Psychoactive drugs (other than alcohol and tobacco) remain the last holdout of the most restrictive form of regulation—criminal prohibition—despite the enthusiastic embrace of market deregulation almost everywhere else. This situation could change if the USA embraced a free market regime for all psychoactive drugs. But as attractive as this approach may be to libertarians, it would not be good public-health policy. Allowing a free market for all currently illicit drugs would add substantially to the harms now caused by alcohol and tobacco.\u003cbr\>The work of Nutt and colleagues is a useful step towards a better evidence base for the formulation of drug policy. They challenge us to find ways to reduce the indefensible disparity between the regulatory treatment of alcohol and tobacco and the most widely used illicit drug, cannabis. The solution could involve a combination of increasing restrictions on the promotion and availability of alcohol and tobacco, while reducing the severity of the statutory penalties for cannabis users.\u003cbr\>\u003cbr\>More rational policies would also avoid thought-avoiding rhetoric such as the so-called war on drugs. Instead, we need to find better ways to reduce the demand for all psychoactive drugs by the youth of developed countries. And we need more humane and effective responses to people who become dependent on psychoactive drugs, despite our best efforts to discourage their use.\u003cbr\>\u003cbr\>\u003cbr\>\u003c/font\>\u003c/p\>\u003c/div\>\u003c/div\>",0]);D(["ce"]);//-->The work of Nutt and colleagues is a useful step towards a better evidence base for the formulation of drug policy. They challenge us to find ways to reduce the indefensible disparity between the regulatory treatment of alcohol and tobacco and the most widely used illicit drug, cannabis. The solution could involve a combination of increasing restrictions on the promotion and availability of alcohol and tobacco, while reducing the severity of the statutory penalties for cannabis users.More rational policies would also avoid thought-avoiding rhetoric such as the so-called war on drugs. Instead, we need to find better ways to reduce the demand for all psychoactive drugs by the youth of developed countries. And we need more humane and effective responses to people who become dependent on psychoactive drugs, despite our best efforts to discourage their use.
Wednesday
CDEP: A Half Glass of Wine Daily May Add Years to Life
CDEP: A Half Glass of Wine Daily May Add Years to Life
By Peggy Peck, Managing Editor, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
March 01, 2007
Martinette T. Streppel, Ph.D. cand., Wageningen U., The Netherlands
ORLANDO, Fla., March 1 -- Men who limited alcohol intake to less than a glass of wine a day lived about four years longer than those who consumed similar amounts of beer or spirits, researchers here reported.
A number of studies have linked alcohol consumption-especially red wine consumption-to decreased risk of cardiovascular events, but Martinette T. Streppel, a Ph.D., student at Wageningen University in Bilhoven, The Netherlands, said this study may be the first to suggest that wine itself confers a survival benefit.
Action Points
§ Explain to interested patients that this report was derived from an observational study and the findings need to be confirmed in a prospective study.
§ This study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary as they have not yet been reviewed and published in a peer-reviewed publication.
Compared with non-drinkers, men who consumed wine, beer, or spirits had a 36% lower risk of all-cause mortality and a 34% lower risk of cardiovascular mortality, she said at the Conference on Cardiovascular Disease Epidemiology and Prevention, which is sponsored by the American Heart Association.
"But men who drank about a half a glass of wine a day had a 40% reduction in all cause mortality and a 48% lower incidence of cardiovascular death," said Daan Kromhout, Ph.D., a professor of public health at Wageningen University and vice president of the Health Council of The Netherlands. Dr. Kromhout was senior author of the paper.
The finding emerged from analysis of data collected in the Zutphen Study, a cohort study of 1,373 men born between 1900 and 1920, which Streppel and colleagues reported. The men were enrolled in the study at age 40 and were followed for an average of 40 years.
Information about alcohol consumption as well as dietary habits, smoking, body mass index, and prevalence of heart disease, stroke, diabetes, and cancer, was collected by seven surveys conducted over the course of the study.
Light alcohol intake was defined as 20 grams or less a day, or about two glasses of wine. The average long-term intake was six grams of alcohol daily, which was equal to four ounces of beer, two ounces of wine, or one ounce of spirits.
Compared with men who did not consume alcoholic beverages, wine drinkers lived 3.8 years longer.
Among the findings:
· 45% of the men used alcohol in 1960, when they were 40 to 60 years old, but 85% of the men who survived until the year 2000 used alcohol.
· In 1960, the average consumption was eight grams of alcohol daily, which increased to 18 grams a day in 1985 and decreased to 13 grams.
· In 1960, 2% of the men were wine drinkers versus more than 40% of the men in the final survey in 2000.
The study did not differentiate between type of wine consumed, said Dr. Kromhout, who added "the type of wine consumed-red or white-usually varies by the season with red wine being more popular during the winter months."
Streppel speculated that the benefit observed for light wine drinkers might be linked to an increase in HDL cholesterol-a finding that has already been reported in other wine studies-or to "inhibition of platelet aggregation associated with wine."
The study was funded by the The Netherlands Food and Consumer Product Safety Authority and The Netherlands National Institute for Public Health and the Environment.
Primary source: Cardiovascular Disease Epidemiology and Prevention
Source reference:
Streppel MT "Long-Term Wine Consumption Is Independent of Moderate Alcohol Related to Cardiovascular Mortality and Live Expectance: the Zutphen Study" P57
By Peggy Peck, Managing Editor, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
March 01, 2007
Martinette T. Streppel, Ph.D. cand., Wageningen U., The Netherlands
ORLANDO, Fla., March 1 -- Men who limited alcohol intake to less than a glass of wine a day lived about four years longer than those who consumed similar amounts of beer or spirits, researchers here reported.
A number of studies have linked alcohol consumption-especially red wine consumption-to decreased risk of cardiovascular events, but Martinette T. Streppel, a Ph.D., student at Wageningen University in Bilhoven, The Netherlands, said this study may be the first to suggest that wine itself confers a survival benefit.
Action Points
§ Explain to interested patients that this report was derived from an observational study and the findings need to be confirmed in a prospective study.
§ This study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary as they have not yet been reviewed and published in a peer-reviewed publication.
Compared with non-drinkers, men who consumed wine, beer, or spirits had a 36% lower risk of all-cause mortality and a 34% lower risk of cardiovascular mortality, she said at the Conference on Cardiovascular Disease Epidemiology and Prevention, which is sponsored by the American Heart Association.
"But men who drank about a half a glass of wine a day had a 40% reduction in all cause mortality and a 48% lower incidence of cardiovascular death," said Daan Kromhout, Ph.D., a professor of public health at Wageningen University and vice president of the Health Council of The Netherlands. Dr. Kromhout was senior author of the paper.
The finding emerged from analysis of data collected in the Zutphen Study, a cohort study of 1,373 men born between 1900 and 1920, which Streppel and colleagues reported. The men were enrolled in the study at age 40 and were followed for an average of 40 years.
Information about alcohol consumption as well as dietary habits, smoking, body mass index, and prevalence of heart disease, stroke, diabetes, and cancer, was collected by seven surveys conducted over the course of the study.
Light alcohol intake was defined as 20 grams or less a day, or about two glasses of wine. The average long-term intake was six grams of alcohol daily, which was equal to four ounces of beer, two ounces of wine, or one ounce of spirits.
Compared with men who did not consume alcoholic beverages, wine drinkers lived 3.8 years longer.
Among the findings:
· 45% of the men used alcohol in 1960, when they were 40 to 60 years old, but 85% of the men who survived until the year 2000 used alcohol.
· In 1960, the average consumption was eight grams of alcohol daily, which increased to 18 grams a day in 1985 and decreased to 13 grams.
· In 1960, 2% of the men were wine drinkers versus more than 40% of the men in the final survey in 2000.
The study did not differentiate between type of wine consumed, said Dr. Kromhout, who added "the type of wine consumed-red or white-usually varies by the season with red wine being more popular during the winter months."
Streppel speculated that the benefit observed for light wine drinkers might be linked to an increase in HDL cholesterol-a finding that has already been reported in other wine studies-or to "inhibition of platelet aggregation associated with wine."
The study was funded by the The Netherlands Food and Consumer Product Safety Authority and The Netherlands National Institute for Public Health and the Environment.
Primary source: Cardiovascular Disease Epidemiology and Prevention
Source reference:
Streppel MT "Long-Term Wine Consumption Is Independent of Moderate Alcohol Related to Cardiovascular Mortality and Live Expectance: the Zutphen Study" P57
Friday
ONDCP vs. DPA on Student Drug Testing
Bertha Madras left the bench (at Harvard) two years ago to go work for ONDCP. Here's an interview with her (sparring with a rep from DPA) on the issue of student drug testing.
After the interview article, there is the statement of the American Academy of Pediatrics on student drug testing.
----------
http://www.msnbc.msn.com/id/16893833/site/newsweek/
WEB EXCLUSIVE
Should Schools Conduct Random Drug Tests?
The White House wants more schools to adopt random student drug-testing programs. NEWSWEEK talks to advocates on both sides of the issue.
By Alexandra Gekas Newsweek Jan. 30, 2007
The White House Office of National Drug Control Policy announced last week that it will be holding four regional summits promoting random student drug testing in public middle and high schools. The controversial program, which has already been implemented in nearly 1,000 middle and high schools across the country, requires that kids submit to random drug testing if they want to participate in competitive extracurricular activities like athletics. The Department of Education offers grants to schools that want to develop or expand a drug-testing programs for children in grades 6-12, but decisions about whether to test and which drugs to test for are made on an individual school level. The testing is usually done by a school nurse with a urine sample taken on school premises. If there's a positive result, the sample is sent out for verification by a lab. Tests can also be done with blood or saliva. Samples are generally tested for cocaine, marijuana, ecstasy, opium-based substances, oxycontin and, in some cases, steroids.
\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>The proposed expansion of the program has prompted fierce debate and raised both privacy and efficacy questions. NEWSWEEK's Alexandra Gekas spoke with advocates on both sides of the issue: Dr. Bertha Madras, the deputy director of Demand Reduction in the ONDCP, which coordinates and promotes President Bush's drug prevention and treatment initiatives; and Jennifer Kern, a research associate with the Drug Policy Alliance, a group opposed to the program. (The interviews were conducted separately, but we've presented the participants' answers side by side.) Excerpts:\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>NEWSWEEK: How does student drug testing work?\u003c/font\> \u003cbr\>\u003cfont size\u003d\"2\"\>Dr. Bertha Madras: Under ideal conditions the testing is random, which is critical. If it's a urine test, the child is asked to come down to the nurse's office. They walk in solo, they deposit a sample as they would in any doctor's office, they give the sample to the nurse who puts a little dip stick in, and the dip stick will say positive or negative. \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Jennifer Kern: They are removed from their classrooms and are escorted to take a drug test, and if they end up with a positive test result they are removed from their extracurricular activity. And because this is a very public removal from the classroom and often a public removal from the extracurricular activity, the testing is not as confidential as promised.\u003c/font\>\u003c/p\>\u003cbr\>\u003cbr\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Is there a standard model for schools to follow when implementing the random testing?\u003c/font\> \u003cbr\>\u003cfont size\u003d\"2\"\>Madras: Schools have done it voluntarily without any federal assistance for a number of years since the 1990s. Once the Supreme Court weighed in, then it became more of a formalized procedure on how you do it and how you develop policies. [In 2002, the Supreme Court ruled that random drug testing of students participating in extracurricular activities does not violate the Constitution.] When grants became available in the Department of Education, then there were guidelines on how to do it. ",1]
);
//-->
The proposed expansion of the program has prompted fierce debate and raised both privacy and efficacy questions. NEWSWEEK's Alexandra Gekas spoke with advocates on both sides of the issue: Dr. Bertha Madras, the deputy director of Demand Reduction in the ONDCP, which coordinates and promotes President Bush's drug prevention and treatment initiatives; and Jennifer Kern, a research associate with the Drug Policy Alliance, a group opposed to the program. (The interviews were conducted separately, but we've presented the participants' answers side by side.) Excerpts:
NEWSWEEK: How does student drug testing work? Dr. Bertha Madras: Under ideal conditions the testing is random, which is critical. If it's a urine test, the child is asked to come down to the nurse's office. They walk in solo, they deposit a sample as they would in any doctor's office, they give the sample to the nurse who puts a little dip stick in, and the dip stick will say positive or negative.
Jennifer Kern: They are removed from their classrooms and are escorted to take a drug test, and if they end up with a positive test result they are removed from their extracurricular activity. And because this is a very public removal from the classroom and often a public removal from the extracurricular activity, the testing is not as confidential as promised.
Is there a standard model for schools to follow when implementing the random testing? Madras: Schools have done it voluntarily without any federal assistance for a number of years since the 1990s. Once the Supreme Court weighed in, then it became more of a formalized procedure on how you do it and how you develop policies. [In 2002, the Supreme Court ruled that random drug testing of students participating in extracurricular activities does not violate the Constitution.] When grants became available in the Department of Education, then there were guidelines on how to do it.
\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: There are model policies that are put out, but there is no legislation or guidelines for schools beyond the Supreme Court decision. [Schools] are not allowed to use the test results in certain ways legally, but in terms of how it is implemented, it varies. For some schools there's no verification on the type of labs they're using so there's a lot of concern that schools are using labs that are not certified or they are using their own staff. No protocol on how schools have to do it exists, so there is concern about schools not knowing what to do, leading to breaches of confidentiality and false positives.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Is anyone monitoring the schools to make sure they are doing it correctly?\u003c/font\> \u003cbr\>\u003cfont size\u003d\"2\"\>Madras: For the federal grants, there are project officers who keep in touch with the schools to see if they're going well. So when it's a federal program there clearly is oversight of the grant. If it's a grass-roots program, of which there are many in the country, then the monitoring is self-monitoring by the schools themselves. The critical thing to bear in mind with this program is the confidential nature of the information. \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: There's no outside monitoring. There's no regulation and there's no check or balance. While some schools describe the program as non-punitive, some schools have very harsh repercussions as far as removing kids from their extracurricular activities for the rest of the year or the rest of their school career. Some schools provide counseling but some provide no services to the students if they test positive. In a lot of places there isn't much money and there aren't many resources for students who test positive.\u003c/font\>\u003c/p\>\u003cbr\>\u003cbr\>\n\u003cp\>\u003cfont size\u003d\"2\"\>What are the penalties or repercussions for positive tests?\u003c/font\> \u003cbr\>\u003cfont size\u003d\"2\"\>Madras: The first repercussion is that the parents are called in and they're told that there is a positive test and we'd like to get help for the child. We can recommend a medical review officer who can go over what the test means and who can provide counseling. Sometimes the counseling is quick because it appears that the problem is not a profound one. At some schools there's no other repercussions in regard to their extracurricular activities, and in some schools the child is not allowed to play competitively for a period of time, but they can continue to practice with the team. ",1]
);
//-->
Kern: There are model policies that are put out, but there is no legislation or guidelines for schools beyond the Supreme Court decision. [Schools] are not allowed to use the test results in certain ways legally, but in terms of how it is implemented, it varies. For some schools there's no verification on the type of labs they're using so there's a lot of concern that schools are using labs that are not certified or they are using their own staff. No protocol on how schools have to do it exists, so there is concern about schools not knowing what to do, leading to breaches of confidentiality and false positives.
Is anyone monitoring the schools to make sure they are doing it correctly? Madras: For the federal grants, there are project officers who keep in touch with the schools to see if they're going well. So when it's a federal program there clearly is oversight of the grant. If it's a grass-roots program, of which there are many in the country, then the monitoring is self-monitoring by the schools themselves. The critical thing to bear in mind with this program is the confidential nature of the information.
Kern: There's no outside monitoring. There's no regulation and there's no check or balance. While some schools describe the program as non-punitive, some schools have very harsh repercussions as far as removing kids from their extracurricular activities for the rest of the year or the rest of their school career. Some schools provide counseling but some provide no services to the students if they test positive. In a lot of places there isn't much money and there aren't many resources for students who test positive.
What are the penalties or repercussions for positive tests? Madras: The first repercussion is that the parents are called in and they're told that there is a positive test and we'd like to get help for the child. We can recommend a medical review officer who can go over what the test means and who can provide counseling. Sometimes the counseling is quick because it appears that the problem is not a profound one. At some schools there's no other repercussions in regard to their extracurricular activities, and in some schools the child is not allowed to play competitively for a period of time, but they can continue to practice with the team.
\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: It's determined by the local school district, so typically it is suspension from an extracurricular activity, although I don't believe they are allowed to punish them in a way that would cause them to not be able to finish their education. Sometimes it can be very harsh and the concern is that extracurricular activities have been proven to keep students engaged and in school during the peak drug hours of 3 p.m. to 6 p.m., when parents are not home.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Is there a risk that kids who test positive for drugs will be stigmatized?\u003c/font\> \u003cbr\>\u003cfont size\u003d\"2\"\>Madras: The thing that I have heard is that everyone knows who's using drugs; there are no surprises amongst the kids. Kids know who are the users, their friends know, so when a kid is not engaged in sports for one game, nobody is surprised. I've been a parent all my life, and I knew which one of the kids I didn't want my kids near. I think the far greater risk is using the drug that can have adverse consequences on brain, body and behavior. \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: What is the point of removing the kids from extracurricular activities when they are most in need of that support and there is the question of confidentiality and those students being labeled as the 'bad kid' and how that effects them?\u003c/font\>\u003c/p\>\u003cbr\>\n\u003cp\>\u003cfont size\u003d\"2\"\>The ONDCP cites a random drug-testing program that was put in place for the military more than 20 years ago as evidence that testing can be effective in reducing drug use.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Madras: When the military began random mandatory testing the tests were 27 percent positive and now they are 1.5 percent. It didn't disappear in one year or two or five, but it declined very steeply and it's been steady for years.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: Military testing has been in place, but some people coming back from certain situations certainly do continue to have substance-abuse problems.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Should a program from the military be applied to kids?",1]
);
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Kern: It's determined by the local school district, so typically it is suspension from an extracurricular activity, although I don't believe they are allowed to punish them in a way that would cause them to not be able to finish their education. Sometimes it can be very harsh and the concern is that extracurricular activities have been proven to keep students engaged and in school during the peak drug hours of 3 p.m. to 6 p.m., when parents are not home.
Is there a risk that kids who test positive for drugs will be stigmatized? Madras: The thing that I have heard is that everyone knows who's using drugs; there are no surprises amongst the kids. Kids know who are the users, their friends know, so when a kid is not engaged in sports for one game, nobody is surprised. I've been a parent all my life, and I knew which one of the kids I didn't want my kids near. I think the far greater risk is using the drug that can have adverse consequences on brain, body and behavior.
Kern: What is the point of removing the kids from extracurricular activities when they are most in need of that support and there is the question of confidentiality and those students being labeled as the 'bad kid' and how that effects them?
The ONDCP cites a random drug-testing program that was put in place for the military more than 20 years ago as evidence that testing can be effective in reducing drug use.
Madras: When the military began random mandatory testing the tests were 27 percent positive and now they are 1.5 percent. It didn't disappear in one year or two or five, but it declined very steeply and it's been steady for years.
Kern: Military testing has been in place, but some people coming back from certain situations certainly do continue to have substance-abuse problems.
Should a program from the military be applied to kids?
\u003cbr\>\u003cfont size\u003d\"2\"\>Madras: I think it's very relevant because what you know is that behavioral modification is always a hybrid of positive and negative reinforcement. If you have a policy that says that drugs are not good for people then you institute a way of trying to modify behavior. The military did it just by random drug testing with consequence, and the same random testing in schools with very, very gentle outcomes or consequences, which are really targeted for the benefit of the child and not for the benefit of the school. And this is a way of enlisting the parents and saying we have to help this child. The deterrent factor in the schools is different than in the military. For the kids, one of the things that deter them is that they don't want to disappoint their parents.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: People who elect to be in the military are going to be very different from people who need to be in high school and they are going to be at very different developmental stages in life, so how drugs affect them are going to be very different. Random drug testing has not been proven to deter drug use. In 2003, the National Institute on Drug Abuse funded the largest study ever conducted on the topic, and the Robert Wood Johnson Foundation backed it up with a second study that same year. Seasoned researchers compared a total of 94,000 students in almost 900 American schools with and without a drug-testing program, and found no differences in illegal drug use among students from both sets of schools.\u003c/font\>\u003c/p\>\u003cbr\>\n\u003cp\>\u003cfont size\u003d\"2\"\>What kind of a message are we sending to kids by saying that we don't trust them when they tell us they aren't doing drugs?\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Madras: I don't think there's a negative message. When I go to schools that have the federal grant they say, "We love it! It gives me an excuse not to use at parties because kids are always pushing on us," but none of them say they're angry with the school. What I've heard above all is "thank you."",1]
);
//-->
Madras: I think it's very relevant because what you know is that behavioral modification is always a hybrid of positive and negative reinforcement. If you have a policy that says that drugs are not good for people then you institute a way of trying to modify behavior. The military did it just by random drug testing with consequence, and the same random testing in schools with very, very gentle outcomes or consequences, which are really targeted for the benefit of the child and not for the benefit of the school. And this is a way of enlisting the parents and saying we have to help this child. The deterrent factor in the schools is different than in the military. For the kids, one of the things that deter them is that they don't want to disappoint their parents.
Kern: People who elect to be in the military are going to be very different from people who need to be in high school and they are going to be at very different developmental stages in life, so how drugs affect them are going to be very different. Random drug testing has not been proven to deter drug use. In 2003, the National Institute on Drug Abuse funded the largest study ever conducted on the topic, and the Robert Wood Johnson Foundation backed it up with a second study that same year. Seasoned researchers compared a total of 94,000 students in almost 900 American schools with and without a drug-testing program, and found no differences in illegal drug use among students from both sets of schools.
What kind of a message are we sending to kids by saying that we don't trust them when they tell us they aren't doing drugs?
Madras: I don't think there's a negative message. When I go to schools that have the federal grant they say, "We love it! It gives me an excuse not to use at parties because kids are always pushing on us," but none of them say they're angry with the school. What I've heard above all is "thank you."
\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: They are undermining the very protective factors that are shown to keep people out of trouble with drugs. For instance, [there are] concerns that the testing breaks down relationships of trust between students and adults at school, hinders open communication and contributes to a hostile school environment and it risks deterring students from extracurricular activities.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Is mandatory drug testing a violation of a student's right to privacy?\u003c/font\> \u003cbr\>\u003cfont size\u003d\"2\"\>Madras: I think that privacy issues are really interesting for adolescents. If a child is doing something that is illegal, then how do we weigh the more important value, which is how to protect a child? Really, ask yourself logically, do you feel young people who don't have a fully developed sense of self should be able to do things that are illegal to harm themselves? \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: [Drug testing ] is only for students who participate in extracurricular activities because the Supreme Court ruled it is permissible to [test] students in those activities because it described them as a privilege. But students in those programs are shown to have fewer problems with drugs so there is concern that it will deter kids from participating in those activities, which help kids feel connected and engaged with school. The Supreme Court decision is treating students like they are guilty until proven innocent.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>-------------\u003c/font\> \u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>entire article:\u003c/font\> \u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>\u003ca href\u003d\"http://pediatrics.aappublications.org/cgi/reprint/119/3/627\" target\u003d\"_blank\" onclick\u003d\"return top.js.OpenExtLink(window,event,this)\"\>http://pediatrics.aappublicatio\u003cWBR\>ns.org/cgi/reprint/119/3/627\u003c/a\>\u003c/font\> \u003c/p\>\u003cbr\>\n\u003cp\>\u003cfont size\u003d\"2\"\>short statement:\u003c/font\> \u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>\u003ca href\u003d\"http://pediatrics.aappublications.org/cgi/content/short/119/3/627\" target\u003d\"_blank\" onclick\u003d\"return top.js.OpenExtLink(window,event,this)\"\>http://pediatrics.aappublicatio",1]
);
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Kern: They are undermining the very protective factors that are shown to keep people out of trouble with drugs. For instance, [there are] concerns that the testing breaks down relationships of trust between students and adults at school, hinders open communication and contributes to a hostile school environment and it risks deterring students from extracurricular activities.
Is mandatory drug testing a violation of a student's right to privacy? Madras: I think that privacy issues are really interesting for adolescents. If a child is doing something that is illegal, then how do we weigh the more important value, which is how to protect a child? Really, ask yourself logically, do you feel young people who don't have a fully developed sense of self should be able to do things that are illegal to harm themselves?
Kern: [Drug testing ] is only for students who participate in extracurricular activities because the Supreme Court ruled it is permissible to [test] students in those activities because it described them as a privilege. But students in those programs are shown to have fewer problems with drugs so there is concern that it will deter kids from participating in those activities, which help kids feel connected and engaged with school. The Supreme Court decision is treating students like they are guilty until proven innocent.
-------------
entire article:
http://pediatrics.aappublications.org/cgi/reprint/119/3/627
short statement:
http://pediatrics.aappublicatio
ns.org/cgi/content/short/119/3\u003cWBR\>/627\u003c/a\>\u003c/font\> \u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>PEDIATRICS Vol. 119 No. 3 March 2007, pp. 627-630\u003c/font\> \u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>POLICY STATEMENT \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Testing for Drugs of Abuse in Children and Adolescents: Addendum—Testing in Schools and at Home\u003c/font\> \u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Committee on Substance Abuse and Council on School Health \u003c/font\>\u003c/p\>\u003cbr\>\n\u003cp\>\u003cfont size\u003d\"2\"\>The American Academy of Pediatrics continues to believe that adolescents should not be drug tested without their knowledge and consent. \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Recent US Supreme Court decisions and market forces have resulted in recommendations for drug testing of adolescents at school and products for parents to use to test adolescents at home. \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>The American Academy of Pediatrics has strong reservations about testing adolescents at school or at home and believes that more research is needed on both safety and efficacy before school-based testing programs are implemented. \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>The American Academy of Pediatrics also believes that more adolescent-specific substance abuse treatment resources are needed to ensure that testing leads to early rehabilitation rather than to punitive measures only. \u003c/font\>\u003c/p\>\u003cbr\>\u003cbr\>\u003cbr\>\u003cbr\>\u003c/div\>\u003c/div\>",0]
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ns.org/cgi/content/short/119/3/627
PEDIATRICS Vol. 119 No. 3 March 2007, pp. 627-630
POLICY STATEMENT
Testing for Drugs of Abuse in Children and Adolescents: Addendum—Testing in Schools and at Home
Committee on Substance Abuse and Council on School Health
The American Academy of Pediatrics continues to believe that adolescents should not be drug tested without their knowledge and consent.
Recent US Supreme Court decisions and market forces have resulted in recommendations for drug testing of adolescents at school and products for parents to use to test adolescents at home.
The American Academy of Pediatrics has strong reservations about testing adolescents at school or at home and believes that more research is needed on both safety and efficacy before school-based testing programs are implemented.
The American Academy of Pediatrics also believes that more adolescent-specific substance abuse treatment resources are needed to ensure that testing leads to early rehabilitation rather than to punitive measures only.
After the interview article, there is the statement of the American Academy of Pediatrics on student drug testing.
----------
http://www.msnbc.msn.com/id/16893833/site/newsweek/
WEB EXCLUSIVE
Should Schools Conduct Random Drug Tests?
The White House wants more schools to adopt random student drug-testing programs. NEWSWEEK talks to advocates on both sides of the issue.
By Alexandra Gekas Newsweek Jan. 30, 2007
The White House Office of National Drug Control Policy announced last week that it will be holding four regional summits promoting random student drug testing in public middle and high schools. The controversial program, which has already been implemented in nearly 1,000 middle and high schools across the country, requires that kids submit to random drug testing if they want to participate in competitive extracurricular activities like athletics. The Department of Education offers grants to schools that want to develop or expand a drug-testing programs for children in grades 6-12, but decisions about whether to test and which drugs to test for are made on an individual school level. The testing is usually done by a school nurse with a urine sample taken on school premises. If there's a positive result, the sample is sent out for verification by a lab. Tests can also be done with blood or saliva. Samples are generally tested for cocaine, marijuana, ecstasy, opium-based substances, oxycontin and, in some cases, steroids.
\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>The proposed expansion of the program has prompted fierce debate and raised both privacy and efficacy questions. NEWSWEEK's Alexandra Gekas spoke with advocates on both sides of the issue: Dr. Bertha Madras, the deputy director of Demand Reduction in the ONDCP, which coordinates and promotes President Bush's drug prevention and treatment initiatives; and Jennifer Kern, a research associate with the Drug Policy Alliance, a group opposed to the program. (The interviews were conducted separately, but we've presented the participants' answers side by side.) Excerpts:\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>NEWSWEEK: How does student drug testing work?\u003c/font\> \u003cbr\>\u003cfont size\u003d\"2\"\>Dr. Bertha Madras: Under ideal conditions the testing is random, which is critical. If it's a urine test, the child is asked to come down to the nurse's office. They walk in solo, they deposit a sample as they would in any doctor's office, they give the sample to the nurse who puts a little dip stick in, and the dip stick will say positive or negative. \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Jennifer Kern: They are removed from their classrooms and are escorted to take a drug test, and if they end up with a positive test result they are removed from their extracurricular activity. And because this is a very public removal from the classroom and often a public removal from the extracurricular activity, the testing is not as confidential as promised.\u003c/font\>\u003c/p\>\u003cbr\>\u003cbr\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Is there a standard model for schools to follow when implementing the random testing?\u003c/font\> \u003cbr\>\u003cfont size\u003d\"2\"\>Madras: Schools have done it voluntarily without any federal assistance for a number of years since the 1990s. Once the Supreme Court weighed in, then it became more of a formalized procedure on how you do it and how you develop policies. [In 2002, the Supreme Court ruled that random drug testing of students participating in extracurricular activities does not violate the Constitution.] When grants became available in the Department of Education, then there were guidelines on how to do it. ",1]
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The proposed expansion of the program has prompted fierce debate and raised both privacy and efficacy questions. NEWSWEEK's Alexandra Gekas spoke with advocates on both sides of the issue: Dr. Bertha Madras, the deputy director of Demand Reduction in the ONDCP, which coordinates and promotes President Bush's drug prevention and treatment initiatives; and Jennifer Kern, a research associate with the Drug Policy Alliance, a group opposed to the program. (The interviews were conducted separately, but we've presented the participants' answers side by side.) Excerpts:
NEWSWEEK: How does student drug testing work? Dr. Bertha Madras: Under ideal conditions the testing is random, which is critical. If it's a urine test, the child is asked to come down to the nurse's office. They walk in solo, they deposit a sample as they would in any doctor's office, they give the sample to the nurse who puts a little dip stick in, and the dip stick will say positive or negative.
Jennifer Kern: They are removed from their classrooms and are escorted to take a drug test, and if they end up with a positive test result they are removed from their extracurricular activity. And because this is a very public removal from the classroom and often a public removal from the extracurricular activity, the testing is not as confidential as promised.
Is there a standard model for schools to follow when implementing the random testing? Madras: Schools have done it voluntarily without any federal assistance for a number of years since the 1990s. Once the Supreme Court weighed in, then it became more of a formalized procedure on how you do it and how you develop policies. [In 2002, the Supreme Court ruled that random drug testing of students participating in extracurricular activities does not violate the Constitution.] When grants became available in the Department of Education, then there were guidelines on how to do it.
\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: There are model policies that are put out, but there is no legislation or guidelines for schools beyond the Supreme Court decision. [Schools] are not allowed to use the test results in certain ways legally, but in terms of how it is implemented, it varies. For some schools there's no verification on the type of labs they're using so there's a lot of concern that schools are using labs that are not certified or they are using their own staff. No protocol on how schools have to do it exists, so there is concern about schools not knowing what to do, leading to breaches of confidentiality and false positives.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Is anyone monitoring the schools to make sure they are doing it correctly?\u003c/font\> \u003cbr\>\u003cfont size\u003d\"2\"\>Madras: For the federal grants, there are project officers who keep in touch with the schools to see if they're going well. So when it's a federal program there clearly is oversight of the grant. If it's a grass-roots program, of which there are many in the country, then the monitoring is self-monitoring by the schools themselves. The critical thing to bear in mind with this program is the confidential nature of the information. \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: There's no outside monitoring. There's no regulation and there's no check or balance. While some schools describe the program as non-punitive, some schools have very harsh repercussions as far as removing kids from their extracurricular activities for the rest of the year or the rest of their school career. Some schools provide counseling but some provide no services to the students if they test positive. In a lot of places there isn't much money and there aren't many resources for students who test positive.\u003c/font\>\u003c/p\>\u003cbr\>\u003cbr\>\n\u003cp\>\u003cfont size\u003d\"2\"\>What are the penalties or repercussions for positive tests?\u003c/font\> \u003cbr\>\u003cfont size\u003d\"2\"\>Madras: The first repercussion is that the parents are called in and they're told that there is a positive test and we'd like to get help for the child. We can recommend a medical review officer who can go over what the test means and who can provide counseling. Sometimes the counseling is quick because it appears that the problem is not a profound one. At some schools there's no other repercussions in regard to their extracurricular activities, and in some schools the child is not allowed to play competitively for a period of time, but they can continue to practice with the team. ",1]
);
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Kern: There are model policies that are put out, but there is no legislation or guidelines for schools beyond the Supreme Court decision. [Schools] are not allowed to use the test results in certain ways legally, but in terms of how it is implemented, it varies. For some schools there's no verification on the type of labs they're using so there's a lot of concern that schools are using labs that are not certified or they are using their own staff. No protocol on how schools have to do it exists, so there is concern about schools not knowing what to do, leading to breaches of confidentiality and false positives.
Is anyone monitoring the schools to make sure they are doing it correctly? Madras: For the federal grants, there are project officers who keep in touch with the schools to see if they're going well. So when it's a federal program there clearly is oversight of the grant. If it's a grass-roots program, of which there are many in the country, then the monitoring is self-monitoring by the schools themselves. The critical thing to bear in mind with this program is the confidential nature of the information.
Kern: There's no outside monitoring. There's no regulation and there's no check or balance. While some schools describe the program as non-punitive, some schools have very harsh repercussions as far as removing kids from their extracurricular activities for the rest of the year or the rest of their school career. Some schools provide counseling but some provide no services to the students if they test positive. In a lot of places there isn't much money and there aren't many resources for students who test positive.
What are the penalties or repercussions for positive tests? Madras: The first repercussion is that the parents are called in and they're told that there is a positive test and we'd like to get help for the child. We can recommend a medical review officer who can go over what the test means and who can provide counseling. Sometimes the counseling is quick because it appears that the problem is not a profound one. At some schools there's no other repercussions in regard to their extracurricular activities, and in some schools the child is not allowed to play competitively for a period of time, but they can continue to practice with the team.
\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: It's determined by the local school district, so typically it is suspension from an extracurricular activity, although I don't believe they are allowed to punish them in a way that would cause them to not be able to finish their education. Sometimes it can be very harsh and the concern is that extracurricular activities have been proven to keep students engaged and in school during the peak drug hours of 3 p.m. to 6 p.m., when parents are not home.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Is there a risk that kids who test positive for drugs will be stigmatized?\u003c/font\> \u003cbr\>\u003cfont size\u003d\"2\"\>Madras: The thing that I have heard is that everyone knows who's using drugs; there are no surprises amongst the kids. Kids know who are the users, their friends know, so when a kid is not engaged in sports for one game, nobody is surprised. I've been a parent all my life, and I knew which one of the kids I didn't want my kids near. I think the far greater risk is using the drug that can have adverse consequences on brain, body and behavior. \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: What is the point of removing the kids from extracurricular activities when they are most in need of that support and there is the question of confidentiality and those students being labeled as the 'bad kid' and how that effects them?\u003c/font\>\u003c/p\>\u003cbr\>\n\u003cp\>\u003cfont size\u003d\"2\"\>The ONDCP cites a random drug-testing program that was put in place for the military more than 20 years ago as evidence that testing can be effective in reducing drug use.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Madras: When the military began random mandatory testing the tests were 27 percent positive and now they are 1.5 percent. It didn't disappear in one year or two or five, but it declined very steeply and it's been steady for years.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: Military testing has been in place, but some people coming back from certain situations certainly do continue to have substance-abuse problems.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Should a program from the military be applied to kids?",1]
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Kern: It's determined by the local school district, so typically it is suspension from an extracurricular activity, although I don't believe they are allowed to punish them in a way that would cause them to not be able to finish their education. Sometimes it can be very harsh and the concern is that extracurricular activities have been proven to keep students engaged and in school during the peak drug hours of 3 p.m. to 6 p.m., when parents are not home.
Is there a risk that kids who test positive for drugs will be stigmatized? Madras: The thing that I have heard is that everyone knows who's using drugs; there are no surprises amongst the kids. Kids know who are the users, their friends know, so when a kid is not engaged in sports for one game, nobody is surprised. I've been a parent all my life, and I knew which one of the kids I didn't want my kids near. I think the far greater risk is using the drug that can have adverse consequences on brain, body and behavior.
Kern: What is the point of removing the kids from extracurricular activities when they are most in need of that support and there is the question of confidentiality and those students being labeled as the 'bad kid' and how that effects them?
The ONDCP cites a random drug-testing program that was put in place for the military more than 20 years ago as evidence that testing can be effective in reducing drug use.
Madras: When the military began random mandatory testing the tests were 27 percent positive and now they are 1.5 percent. It didn't disappear in one year or two or five, but it declined very steeply and it's been steady for years.
Kern: Military testing has been in place, but some people coming back from certain situations certainly do continue to have substance-abuse problems.
Should a program from the military be applied to kids?
\u003cbr\>\u003cfont size\u003d\"2\"\>Madras: I think it's very relevant because what you know is that behavioral modification is always a hybrid of positive and negative reinforcement. If you have a policy that says that drugs are not good for people then you institute a way of trying to modify behavior. The military did it just by random drug testing with consequence, and the same random testing in schools with very, very gentle outcomes or consequences, which are really targeted for the benefit of the child and not for the benefit of the school. And this is a way of enlisting the parents and saying we have to help this child. The deterrent factor in the schools is different than in the military. For the kids, one of the things that deter them is that they don't want to disappoint their parents.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: People who elect to be in the military are going to be very different from people who need to be in high school and they are going to be at very different developmental stages in life, so how drugs affect them are going to be very different. Random drug testing has not been proven to deter drug use. In 2003, the National Institute on Drug Abuse funded the largest study ever conducted on the topic, and the Robert Wood Johnson Foundation backed it up with a second study that same year. Seasoned researchers compared a total of 94,000 students in almost 900 American schools with and without a drug-testing program, and found no differences in illegal drug use among students from both sets of schools.\u003c/font\>\u003c/p\>\u003cbr\>\n\u003cp\>\u003cfont size\u003d\"2\"\>What kind of a message are we sending to kids by saying that we don't trust them when they tell us they aren't doing drugs?\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Madras: I don't think there's a negative message. When I go to schools that have the federal grant they say, "We love it! It gives me an excuse not to use at parties because kids are always pushing on us," but none of them say they're angry with the school. What I've heard above all is "thank you."",1]
);
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Madras: I think it's very relevant because what you know is that behavioral modification is always a hybrid of positive and negative reinforcement. If you have a policy that says that drugs are not good for people then you institute a way of trying to modify behavior. The military did it just by random drug testing with consequence, and the same random testing in schools with very, very gentle outcomes or consequences, which are really targeted for the benefit of the child and not for the benefit of the school. And this is a way of enlisting the parents and saying we have to help this child. The deterrent factor in the schools is different than in the military. For the kids, one of the things that deter them is that they don't want to disappoint their parents.
Kern: People who elect to be in the military are going to be very different from people who need to be in high school and they are going to be at very different developmental stages in life, so how drugs affect them are going to be very different. Random drug testing has not been proven to deter drug use. In 2003, the National Institute on Drug Abuse funded the largest study ever conducted on the topic, and the Robert Wood Johnson Foundation backed it up with a second study that same year. Seasoned researchers compared a total of 94,000 students in almost 900 American schools with and without a drug-testing program, and found no differences in illegal drug use among students from both sets of schools.
What kind of a message are we sending to kids by saying that we don't trust them when they tell us they aren't doing drugs?
Madras: I don't think there's a negative message. When I go to schools that have the federal grant they say, "We love it! It gives me an excuse not to use at parties because kids are always pushing on us," but none of them say they're angry with the school. What I've heard above all is "thank you."
\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: They are undermining the very protective factors that are shown to keep people out of trouble with drugs. For instance, [there are] concerns that the testing breaks down relationships of trust between students and adults at school, hinders open communication and contributes to a hostile school environment and it risks deterring students from extracurricular activities.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Is mandatory drug testing a violation of a student's right to privacy?\u003c/font\> \u003cbr\>\u003cfont size\u003d\"2\"\>Madras: I think that privacy issues are really interesting for adolescents. If a child is doing something that is illegal, then how do we weigh the more important value, which is how to protect a child? Really, ask yourself logically, do you feel young people who don't have a fully developed sense of self should be able to do things that are illegal to harm themselves? \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Kern: [Drug testing ] is only for students who participate in extracurricular activities because the Supreme Court ruled it is permissible to [test] students in those activities because it described them as a privilege. But students in those programs are shown to have fewer problems with drugs so there is concern that it will deter kids from participating in those activities, which help kids feel connected and engaged with school. The Supreme Court decision is treating students like they are guilty until proven innocent.\u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>-------------\u003c/font\> \u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>entire article:\u003c/font\> \u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>\u003ca href\u003d\"http://pediatrics.aappublications.org/cgi/reprint/119/3/627\" target\u003d\"_blank\" onclick\u003d\"return top.js.OpenExtLink(window,event,this)\"\>http://pediatrics.aappublicatio\u003cWBR\>ns.org/cgi/reprint/119/3/627\u003c/a\>\u003c/font\> \u003c/p\>\u003cbr\>\n\u003cp\>\u003cfont size\u003d\"2\"\>short statement:\u003c/font\> \u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>\u003ca href\u003d\"http://pediatrics.aappublications.org/cgi/content/short/119/3/627\" target\u003d\"_blank\" onclick\u003d\"return top.js.OpenExtLink(window,event,this)\"\>http://pediatrics.aappublicatio",1]
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Kern: They are undermining the very protective factors that are shown to keep people out of trouble with drugs. For instance, [there are] concerns that the testing breaks down relationships of trust between students and adults at school, hinders open communication and contributes to a hostile school environment and it risks deterring students from extracurricular activities.
Is mandatory drug testing a violation of a student's right to privacy? Madras: I think that privacy issues are really interesting for adolescents. If a child is doing something that is illegal, then how do we weigh the more important value, which is how to protect a child? Really, ask yourself logically, do you feel young people who don't have a fully developed sense of self should be able to do things that are illegal to harm themselves?
Kern: [Drug testing ] is only for students who participate in extracurricular activities because the Supreme Court ruled it is permissible to [test] students in those activities because it described them as a privilege. But students in those programs are shown to have fewer problems with drugs so there is concern that it will deter kids from participating in those activities, which help kids feel connected and engaged with school. The Supreme Court decision is treating students like they are guilty until proven innocent.
-------------
entire article:
http://pediatrics.aappublications.org/cgi/reprint/119/3/627
short statement:
http://pediatrics.aappublicatio
ns.org/cgi/content/short/119/3\u003cWBR\>/627\u003c/a\>\u003c/font\> \u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>PEDIATRICS Vol. 119 No. 3 March 2007, pp. 627-630\u003c/font\> \u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>POLICY STATEMENT \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Testing for Drugs of Abuse in Children and Adolescents: Addendum—Testing in Schools and at Home\u003c/font\> \u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Committee on Substance Abuse and Council on School Health \u003c/font\>\u003c/p\>\u003cbr\>\n\u003cp\>\u003cfont size\u003d\"2\"\>The American Academy of Pediatrics continues to believe that adolescents should not be drug tested without their knowledge and consent. \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>Recent US Supreme Court decisions and market forces have resulted in recommendations for drug testing of adolescents at school and products for parents to use to test adolescents at home. \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>The American Academy of Pediatrics has strong reservations about testing adolescents at school or at home and believes that more research is needed on both safety and efficacy before school-based testing programs are implemented. \u003c/font\>\u003c/p\>\n\u003cp\>\u003cfont size\u003d\"2\"\>The American Academy of Pediatrics also believes that more adolescent-specific substance abuse treatment resources are needed to ensure that testing leads to early rehabilitation rather than to punitive measures only. \u003c/font\>\u003c/p\>\u003cbr\>\u003cbr\>\u003cbr\>\u003cbr\>\u003c/div\>\u003c/div\>",0]
);
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ns.org/cgi/content/short/119/3/627
PEDIATRICS Vol. 119 No. 3 March 2007, pp. 627-630
POLICY STATEMENT
Testing for Drugs of Abuse in Children and Adolescents: Addendum—Testing in Schools and at Home
Committee on Substance Abuse and Council on School Health
The American Academy of Pediatrics continues to believe that adolescents should not be drug tested without their knowledge and consent.
Recent US Supreme Court decisions and market forces have resulted in recommendations for drug testing of adolescents at school and products for parents to use to test adolescents at home.
The American Academy of Pediatrics has strong reservations about testing adolescents at school or at home and believes that more research is needed on both safety and efficacy before school-based testing programs are implemented.
The American Academy of Pediatrics also believes that more adolescent-specific substance abuse treatment resources are needed to ensure that testing leads to early rehabilitation rather than to punitive measures only.
Wednesday
Trans-Fat in the Montgomery Gazette
Leggett proposes aid for courthouse, tennis bubble
Proposal to ban trans fats set for next week;
council will consider changing who decides arts funding
Janel Davis
The amendments come a week after the executive released his record $4.1 billion spending proposal for fiscal 2008, which begins July 1.
The proposed changes to the capital budget do not add spending or meet the higher borrowing limits set by the council in February. Instead, they fit within the previously approved — and lower — spending limits, according to a March 19 memo Leggett (D) sent the council.
Among the adjustments is $200,000 for structural repairs to the Red Brick Courthouse in Rockville and $468,000 for renovation of the Wheaton Tennis Bubble.
The council will hold public hearings on the operating and construction budgets in April. It also will determine whether to include Leggett’s changes with projects requested by council members. Some council members’ requests include money to accelerate the Germantown Town Center’s Urban Park project by one year, proposed by Councilman Michael J. Knapp (D-Dist. 2) of Germantown.
The county budget must be approved by June 1.
Trans fats
Next week, Councilwoman Duchy Trachtenberg plans to propose a ban on trans fats in county restaurants. Trans fats have been found to raise bad cholesterol. If approved, Montgomery County will be the first county in the nation to levy such a ban. New York City enacted a similar ban in December.
‘‘This is a solid example of when government protects public health and at the same time catches up to public demand,” said Trachtenberg (D-At large) of North Bethesda.
In conjunction with introducing her ban, Trachtenberg is hosting a healthy cooking demonstration on Monday in the Executive Office Building cafeteria with chefs from Marriott and the Silver Diner.
Trachtenberg’s bill would require restaurants to change their cooking habits by Jan. 1.
Proposal to ban trans fats set for next week;
council will consider changing who decides arts funding
Janel Davis
The amendments come a week after the executive released his record $4.1 billion spending proposal for fiscal 2008, which begins July 1.
The proposed changes to the capital budget do not add spending or meet the higher borrowing limits set by the council in February. Instead, they fit within the previously approved — and lower — spending limits, according to a March 19 memo Leggett (D) sent the council.
Among the adjustments is $200,000 for structural repairs to the Red Brick Courthouse in Rockville and $468,000 for renovation of the Wheaton Tennis Bubble.
The council will hold public hearings on the operating and construction budgets in April. It also will determine whether to include Leggett’s changes with projects requested by council members. Some council members’ requests include money to accelerate the Germantown Town Center’s Urban Park project by one year, proposed by Councilman Michael J. Knapp (D-Dist. 2) of Germantown.
The county budget must be approved by June 1.
Trans fats
Next week, Councilwoman Duchy Trachtenberg plans to propose a ban on trans fats in county restaurants. Trans fats have been found to raise bad cholesterol. If approved, Montgomery County will be the first county in the nation to levy such a ban. New York City enacted a similar ban in December.
‘‘This is a solid example of when government protects public health and at the same time catches up to public demand,” said Trachtenberg (D-At large) of North Bethesda.
In conjunction with introducing her ban, Trachtenberg is hosting a healthy cooking demonstration on Monday in the Executive Office Building cafeteria with chefs from Marriott and the Silver Diner.
Trachtenberg’s bill would require restaurants to change their cooking habits by Jan. 1.
Tuesday
Sunday
Saturday
Review of Addiction on HBO from the NY Times
Review of Addiction on HBO from the NY Times----http://www.nytimes.com/2007/03/15/arts/television/15addi.html?_r=1&oref=sloginMarch 15, 2007TV Review 'Addiction'When the Cravings Won't Quit, Turn On the CameraBy VIRGINIA HEFFERNANThis just in from pseudoscience: Addiction documentaries contain an element that excites dopamine receptors, shuts down the frontal lobe and causes intense cravings.Pseudoscientists don't know yet whether drug-documentary addicts are hooked by the gruesomely thrilling scenes of tourniquets and needles, the photos of pre-Vicodin fifth graders or the promise of redemption through higher powers. But something definitely sets the brain reeling with manic questions: How could they fall so far? How could so many of us? Whom will addiction strike next, and will the culprit be the demon rum or the demon OxyContin?The American addiction story, as refined by Alcoholics Anonymous, tells of good folks turned bad - of men taking drinks and drinks taking men. No wonder we crave this story: It's the master narrative of innocence and fall, complete with the possibility of deliverance. Nor is it any wonder that HBO has embraced the genre with its current authoritarian gusto. That channel's "Addiction," an anthology of short films by famous documentary filmmakers, has its premiere tonight.
The blunt title holds promise. As a story, addiction to drugs and alcohol has a chilling and ritualistic arc. Typically, the variable is the drug. Some viewers go for the methamphetamine documentaries, with their slightly high-handed attitude toward the Midwest, their contested statistics and their focus on dental issues. Other viewers prefer the shadowy, stylish heroin ones, with the sexy, skinny kids and "Requiem for a Dream" fashion.\u003cbr /\>\u003cbr /\>When it comes to drug-addiction TV, I\'m a garbagehead: I watch it all. But to my amazement, "Addiction" doesn\'t quite hit the spot. Someone at HBO seems to have instructed the esteemed filmmakers - auteurs like Albert Maysles and D. A. Pennebaker, even - to deny ravenous viewers what they want. The film is bereft of feel-good scenes and drug-movie clichés. As such, the shorts can build a cumulative sense of deprivation.\u003cbr /\>\u003cbr /\>Don\'t expect needles here, in other words, or ravaged street kids turning tricks, or spectacular scenes of delirium tremens. No one even gets high in "Addiction"; no fervid expression gives way to one of stoned beatitude. It\'s enough to make you kind of mad: "Addiction" is holding out on us. And, surely, this is the point.\u003cbr /\>\u003cbr /\>The program is part of a solemn project, something that Sheila Nevins, the enterprising president of HBO Documentary Films, has called "didactic television." It is also devised to be more accessible than past HBO projects, with some cable systems, including RCN in the New York City area, showing it free during its first four-day run.\u003cbr /\>\u003cbr /\>Intended to do more than entertain or alarm, then, "Addiction" is meant to sober people up. To that end, its message is this: Drug and alcohol addiction are diseases of the brain, and they can be treated, at least partly, with medicine.\u003cbr /\>\u003cbr /\>This straightforward message is remarkable for at least two reasons. First, it\'s intrinsically controversial, since A.A. for a long time expected its participants to refrain entirely from drug use, even prescription pills. The model of addiction presented here - addiction as a brain disease - is somewhat at odds with the cognitive model used in classic 12-step programs.\u003cbr /\>",1]
);
//-->
The blunt title holds promise. As a story, addiction to drugs and alcohol has a chilling and ritualistic arc. Typically, the variable is the drug. Some viewers go for the methamphetamine documentaries, with their slightly high-handed attitude toward the Midwest, their contested statistics and their focus on dental issues. Other viewers prefer the shadowy, stylish heroin ones, with the sexy, skinny kids and "Requiem for a Dream" fashion.When it comes to drug-addiction TV, I'm a garbagehead: I watch it all. But to my amazement, "Addiction" doesn't quite hit the spot. Someone at HBO seems to have instructed the esteemed filmmakers - auteurs like Albert Maysles and D. A. Pennebaker, even - to deny ravenous viewers what they want. The film is bereft of feel-good scenes and drug-movie clichés. As such, the shorts can build a cumulative sense of deprivation.Don't expect needles here, in other words, or ravaged street kids turning tricks, or spectacular scenes of delirium tremens. No one even gets high in "Addiction"; no fervid expression gives way to one of stoned beatitude. It's enough to make you kind of mad: "Addiction" is holding out on us. And, surely, this is the point.The program is part of a solemn project, something that Sheila Nevins, the enterprising president of HBO Documentary Films, has called "didactic television." It is also devised to be more accessible than past HBO projects, with some cable systems, including RCN in the New York City area, showing it free during its first four-day run.Intended to do more than entertain or alarm, then, "Addiction" is meant to sober people up. To that end, its message is this: Drug and alcohol addiction are diseases of the brain, and they can be treated, at least partly, with medicine.This straightforward message is remarkable for at least two reasons. First, it's intrinsically controversial, since A.A. for a long time expected its participants to refrain entirely from drug use, even prescription pills. The model of addiction presented here - addiction as a brain disease - is somewhat at odds with the cognitive model used in classic 12-step programs.
Second, it\'s remarkable that so many top-notch filmmakers have consented to push someone else\'s point so hard. It\'s almost ominous. The sameness of the films in "Addiction" might aid its effectiveness as propaganda, but as art it\'s monotone; it\'s hard to believe it\'s the collaborative work of so many otherwise individualistic artists.\u003cbr /\>\u003cbr /\>Evidently, filmmakers submitted film to HBO, which took over postproduction. As a result, each installment mixes vérité and to-the-camera interviews in precisely the same proportions; employs explanatory title cards and interviews with experts; showily defers to the experts, most of them M.D.\'s and Ph.D.\'s; refrains from using graphics, humor or archival photographs; and keeps sound bites short.\u003cbr /\>\u003cbr /\>An exception here is Barbara Kopple. Her short film "Steamfitters Local Union 638" is crisp tonic with lime. Unlike the other filmmakers, she has stuck to her interests and her aesthetic, making a film about a labor union that now actively supports its members who want treatment for addictions. The faces and voices of the union members, many of whom have been installing heating, ventilation and air-conditioning systems for decades, are like nobody else\'s in "Addiction," and indeed like those of few other people\'s on television.\u003cbr /\>\u003cbr /\>"We were the hardest-working," says one union lifer, remembering the \'60s, when he was drinking daily on the job. "We were the biggest drinkers." He recalls how the members used to enable one another as drinkers, helping them lie to their wives and families and still be paid.\u003cbr /\>\u003cbr /\>Now the union uses the same infrastructure of loyalty to help people into detox and rehabilitation. Steamfitters like them - with mustaches and paunches like theirs - join them in meetings; there\'s no interference from management or doctors. As rendered, this is an extremely effective, and good-natured, program.\u003cbr /\>\u003cbr /\>By presenting both addiction and recovery as community affairs, only "Steamfitters Local Union 638" has added something beyond the brain-scan science to these drug and alcohol stories. Still, as I detoxed from the sensationalism I had gotten from other films and had been hoping for in "Addiction," I also came to appreciate other parts of the program. One was the short by Chris Hegedus and Mr. Pennebaker. In their story of two young addicts who try a new Methadone-like drug to treat their cravings for prescription pills, the melancholy Amanda caught my eye. She\'s kind of a lazy oracle.\u003cbr /\>\u003cbr /\>As she\'s driving to the clinic for the first time, contemplating the new drug that she\'s hoping will relieve her dopesickness, she seems to speak for every kind of addict, as well as about the paradox of treating drug addiction with drugs.\u003cbr /\>\u003cbr /\>As Amanda says, "I hope it works as good as everybody says it does, so I don\'t have to worry about feeling like this anymore."\u003cbr /\>\u003cbr /\>\u003cbr /\>\u003cbr /\>\u003c/div\>",0]
);
//-->
Second, it's remarkable that so many top-notch filmmakers have consented to push someone else's point so hard. It's almost ominous. The sameness of the films in "Addiction" might aid its effectiveness as propaganda, but as art it's monotone; it's hard to believe it's the collaborative work of so many otherwise individualistic artists.Evidently, filmmakers submitted film to HBO, which took over postproduction. As a result, each installment mixes vérité and to-the-camera interviews in precisely the same proportions; employs explanatory title cards and interviews with experts; showily defers to the experts, most of them M.D.'s and Ph.D.'s; refrains from using graphics, humor or archival photographs; and keeps sound bites short.An exception here is Barbara Kopple. Her short film "Steamfitters Local Union 638" is crisp tonic with lime. Unlike the other filmmakers, she has stuck to her interests and her aesthetic, making a film about a labor union that now actively supports its members who want treatment for addictions. The faces and voices of the union members, many of whom have been installing heating, ventilation and air-conditioning systems for decades, are like nobody else's in "Addiction," and indeed like those of few other people's on television."We were the hardest-working," says one union lifer, remembering the '60s, when he was drinking daily on the job. "We were the biggest drinkers." He recalls how the members used to enable one another as drinkers, helping them lie to their wives and families and still be paid.Now the union uses the same infrastructure of loyalty to help people into detox and rehabilitation. Steamfitters like them - with mustaches and paunches like theirs - join them in meetings; there's no interference from management or doctors. As rendered, this is an extremely effective, and good-natured, program.By presenting both addiction and recovery as community affairs, only "Steamfitters Local Union 638" has added something beyond the brain-scan science to these drug and alcohol stories. Still, as I detoxed from the sensationalism I had gotten from other films and had been hoping for in "Addiction," I also came to appreciate other parts of the program. One was the short by Chris Hegedus and Mr. Pennebaker. In their story of two young addicts who try a new Methadone-like drug to treat their cravings for prescription pills, the melancholy Amanda caught my eye. She's kind of a lazy oracle.As she's driving to the clinic for the first time, contemplating the new drug that she's hoping will relieve her dopesickness, she seems to speak for every kind of addict, as well as about the paradox of treating drug addiction with drugs.As Amanda says, "I hope it works as good as everybody says it does, so I don't have to worry about feeling like this anymore."
NIDA Conference on Pain, Opioids and Addiction
Video now Available: NIDA Conference on Pain, Opioids and Addiction: An Urgent Problem for Doctors and Patients
http://videocast.nih.gov/ram/nida030507.ram Day 1
http://videocast.nih.gov/ram/nida030607.ram Day 2
More Info:
http://videocast.nih.gov/PastEventDetail.asp?13696
Title: Pain, Opioids and Addiction: An Urgent Problem for Doctors and Patients (Day 1)
Date: Tuesday, March 06, 2007, 8:30:00 AM
Category: Conferences
Description: This joint NIH/NIDA/AMA meeting will bring together the research and clinical practice communities through its co-sponsorship with the AMA, and supported by the NIH Pain Consortium to draw attention to the growing problem of prescription opioid misuse by patients with chronic non-malignant pain conditions. The most powerful treatments available for most forms of pain are opioids. However, opioid treatment can produce negative health consequences, such as intoxication and physical dependence, and may result in opioid abuse and addiction. The prevalence of, and the process of how to prevent, reduce and treat these negative health consequences are not well understood. The goal is to inform practitioners and scientists on emerging research on pain and addiction and what we are learning about how to most effectively and compassionately treat these conditions, while minimizing the risk of abuse and addiction.
http://conferences.masimax.com/opioid
Author: National Institute on Drug Abuse and American Medical Association
Runtime: 04:08:44
Electronic Links: http://videocast.nih.gov/launch.asp?13698
CIT ID: 13698
http://videocast.nih.gov/PastEventDetail.asp?13698
Pain, Opioids and Addiction: An Urgent Problem for Doctors and Patients (Day 2)
Date: Tuesday, March 06, 2007, 8:30:00 AM
Category: Conferences
Description: This joint NIH/NIDA/AMA meeting will bring together the research and clinical practice communities through its co-sponsorship with the AMA, and supported by the NIH Pain Consortium to draw attention to the growing problem of prescription opioid misuse by patients with chronic non-malignant pain conditions. The most powerful treatments available for most forms of pain are opioids. However, opioid treatment can produce negative health consequences, such as intoxication and physical dependence, and may result in opioid abuse and addiction. The prevalence of, and the process of how to prevent, reduce and treat these negative health consequences are not well understood. The goal is to inform practitioners and scientists on emerging research on pain and addiction and what we are learning about how to most effectively and compassionately treat these conditions, while minimizing the risk of abuse and addiction.
http://conferences.masimax.com/opioid
Author: National Institute on Drug Abuse and American Medical Association
Runtime: 04:08:44
Electronic Links: http://videocast.nih.gov/launch.asp?13698
CIT ID: 13698
http://videocast.nih.gov/ram/nida030507.ram Day 1
http://videocast.nih.gov/ram/nida030607.ram Day 2
More Info:
http://videocast.nih.gov/PastEventDetail.asp?13696
Title: Pain, Opioids and Addiction: An Urgent Problem for Doctors and Patients (Day 1)
Date: Tuesday, March 06, 2007, 8:30:00 AM
Category: Conferences
Description: This joint NIH/NIDA/AMA meeting will bring together the research and clinical practice communities through its co-sponsorship with the AMA, and supported by the NIH Pain Consortium to draw attention to the growing problem of prescription opioid misuse by patients with chronic non-malignant pain conditions. The most powerful treatments available for most forms of pain are opioids. However, opioid treatment can produce negative health consequences, such as intoxication and physical dependence, and may result in opioid abuse and addiction. The prevalence of, and the process of how to prevent, reduce and treat these negative health consequences are not well understood. The goal is to inform practitioners and scientists on emerging research on pain and addiction and what we are learning about how to most effectively and compassionately treat these conditions, while minimizing the risk of abuse and addiction.
http://conferences.masimax.com/opioid
Author: National Institute on Drug Abuse and American Medical Association
Runtime: 04:08:44
Electronic Links: http://videocast.nih.gov/launch.asp?13698
CIT ID: 13698
http://videocast.nih.gov/PastEventDetail.asp?13698
Pain, Opioids and Addiction: An Urgent Problem for Doctors and Patients (Day 2)
Date: Tuesday, March 06, 2007, 8:30:00 AM
Category: Conferences
Description: This joint NIH/NIDA/AMA meeting will bring together the research and clinical practice communities through its co-sponsorship with the AMA, and supported by the NIH Pain Consortium to draw attention to the growing problem of prescription opioid misuse by patients with chronic non-malignant pain conditions. The most powerful treatments available for most forms of pain are opioids. However, opioid treatment can produce negative health consequences, such as intoxication and physical dependence, and may result in opioid abuse and addiction. The prevalence of, and the process of how to prevent, reduce and treat these negative health consequences are not well understood. The goal is to inform practitioners and scientists on emerging research on pain and addiction and what we are learning about how to most effectively and compassionately treat these conditions, while minimizing the risk of abuse and addiction.
http://conferences.masimax.com/opioid
Author: National Institute on Drug Abuse and American Medical Association
Runtime: 04:08:44
Electronic Links: http://videocast.nih.gov/launch.asp?13698
CIT ID: 13698
Wednesday
reward and compulsion
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1K-4N08M2P-2&_user=861681&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000046147&_version=1&_urlVersion=0&_userid=861681&md5=5183a2479d1cd527aa2257322567bbe7
Brain reward systems and compulsive drug use
Paul J. Kennya, aDepartment of Biochemistry, The Scripps Research Institute, Jupiter, FL 33458, USA Available online 5 February 2007.
Compulsive drug intake is a hallmark of addiction, yet a mechanistic understanding of this process has been elusive. Drug use is initiated primarily to obtain the excitatory actions of addictive drugs on brain reward systems. Paradoxically, excessive drug intake can decrease the activity of reward systems, reflected in elevated intracranial self-stimulation thresholds in rats, probably by engaging compensatory mechanisms to counter drug effects. Recent evidence suggests that compulsive drug intake might develop in response to such adaptive decreases in brain reward systems. Further, the actions of addictive drugs on reward systems are susceptible to classical conditioning processes, providing a potential mechanism by which drug-paired stimuli can induce powerful cravings and precipitate relapse in abstinent drug users. These findings provide a conceptual framework for improving our understanding of compulsive drug use, and might facilitate the development of novel therapeutics for substance abuse disorders.
Glossary
Action–outcome (goal-directed) responding
behavior directed toward achieving a goal, and is under voluntary control (i.e. sensitive to the relative value of the goal). Action-outcome responding is dependent upon the animal learning the causal relationship between its actions and the likelihood of achieving the goal.
Classical conditioning
originally characterized by the Russian physiologist Ivan Pavlov, and involves the learning process in which a previously neutral environmental cue (CS) can attain motivational salience and elicit a conditioned response after being repeatedly associated with an intrinsically salient stimulus (unconditioned stimulus; US) that induces an automatic response (unconditioned response). In our experiments, a CS (previously neutral flashing light and tone) is repeatedly paired with a US, usually a drug of abuse or a receptor antagonist that precipitates withdrawal in drug-dependent animals, during daily conditioning sessions. The CS can eventually elicit responses similar to those induced by the US.
Escalation of drug intake
in rats is the process by which extended daily access to a drug results in the gradual increase of drug intake over time, a process reminiscent of the loss of control over intake usually observed in human drug addicts.
Intracranial self-stimulation (ICSS)
a behavioral procedure that provides a sensitive measure of the effects of addictive drugs on brain reward systems. Rats turn a response wheel to receive electrical pulses directly into their brain through indwelling stimulating electrodes located within components of the reward system of the brain. In our experiments, the stimulating electrode is located within the posterior lateral hypothalamus, targeting the medial forebrain bundle. The intensity of the electrical pulse is varied (according to the method of limits), such that the minimal electrical intensity (termed the ‘reward threshold’) for which the animal is prepared to respond can be identified for each rat. Acute administration of major drugs of abuse lowers the reward threshold, whereas withdrawal from addictive drugs after chronic administration usually elevates the reward threshold.
Precipitated withdrawal
the process by which withdrawal might be transiently ‘precipitated’ in drug-dependent animals (or humans) by administration of a compound that antagonizes the actions of that particular drug. For example, withdrawal might be precipitated in opiate-dependent rats by administration of the opioid receptor antagonist naloxone.
Reinforcer
an object or event that is obtained or that occurs in response to a particular behavior, is contiguous with that behavioral response in a temporal and spatial manner and is associated with an increased probability that the behavior response will occur again. Put simply, a reinforcer is anything that increases the likelihood that a given response will be repeated.
Stimulus–response (habit) responding
usually emerges after goal-directed responding has been repeated on many occasions, until such responding becomes more habitual and sensitive to goal-associated conditioned stimuli, and less under voluntary control (i.e. insensitive to the relative value of the goal).
Brain reward systems and compulsive drug use
Paul J. Kennya, aDepartment of Biochemistry, The Scripps Research Institute, Jupiter, FL 33458, USA Available online 5 February 2007.
Compulsive drug intake is a hallmark of addiction, yet a mechanistic understanding of this process has been elusive. Drug use is initiated primarily to obtain the excitatory actions of addictive drugs on brain reward systems. Paradoxically, excessive drug intake can decrease the activity of reward systems, reflected in elevated intracranial self-stimulation thresholds in rats, probably by engaging compensatory mechanisms to counter drug effects. Recent evidence suggests that compulsive drug intake might develop in response to such adaptive decreases in brain reward systems. Further, the actions of addictive drugs on reward systems are susceptible to classical conditioning processes, providing a potential mechanism by which drug-paired stimuli can induce powerful cravings and precipitate relapse in abstinent drug users. These findings provide a conceptual framework for improving our understanding of compulsive drug use, and might facilitate the development of novel therapeutics for substance abuse disorders.
Glossary
Action–outcome (goal-directed) responding
behavior directed toward achieving a goal, and is under voluntary control (i.e. sensitive to the relative value of the goal). Action-outcome responding is dependent upon the animal learning the causal relationship between its actions and the likelihood of achieving the goal.
Classical conditioning
originally characterized by the Russian physiologist Ivan Pavlov, and involves the learning process in which a previously neutral environmental cue (CS) can attain motivational salience and elicit a conditioned response after being repeatedly associated with an intrinsically salient stimulus (unconditioned stimulus; US) that induces an automatic response (unconditioned response). In our experiments, a CS (previously neutral flashing light and tone) is repeatedly paired with a US, usually a drug of abuse or a receptor antagonist that precipitates withdrawal in drug-dependent animals, during daily conditioning sessions. The CS can eventually elicit responses similar to those induced by the US.
Escalation of drug intake
in rats is the process by which extended daily access to a drug results in the gradual increase of drug intake over time, a process reminiscent of the loss of control over intake usually observed in human drug addicts.
Intracranial self-stimulation (ICSS)
a behavioral procedure that provides a sensitive measure of the effects of addictive drugs on brain reward systems. Rats turn a response wheel to receive electrical pulses directly into their brain through indwelling stimulating electrodes located within components of the reward system of the brain. In our experiments, the stimulating electrode is located within the posterior lateral hypothalamus, targeting the medial forebrain bundle. The intensity of the electrical pulse is varied (according to the method of limits), such that the minimal electrical intensity (termed the ‘reward threshold’) for which the animal is prepared to respond can be identified for each rat. Acute administration of major drugs of abuse lowers the reward threshold, whereas withdrawal from addictive drugs after chronic administration usually elevates the reward threshold.
Precipitated withdrawal
the process by which withdrawal might be transiently ‘precipitated’ in drug-dependent animals (or humans) by administration of a compound that antagonizes the actions of that particular drug. For example, withdrawal might be precipitated in opiate-dependent rats by administration of the opioid receptor antagonist naloxone.
Reinforcer
an object or event that is obtained or that occurs in response to a particular behavior, is contiguous with that behavioral response in a temporal and spatial manner and is associated with an increased probability that the behavior response will occur again. Put simply, a reinforcer is anything that increases the likelihood that a given response will be repeated.
Stimulus–response (habit) responding
usually emerges after goal-directed responding has been repeated on many occasions, until such responding becomes more habitual and sensitive to goal-associated conditioned stimuli, and less under voluntary control (i.e. insensitive to the relative value of the goal).
Monday
Student Drug Testing
Student Drug Testing
Many of you will recall that Bertha Madras left the bench (at Harvard) two years ago to go work for ONDCP. Here's an interview with her (sparring with a rep from DPA) on the issue of student drug testing.
After the interview article, there is the statement of the American Academy of Pediatrics on student drug testing.
----------
http://www.msnbc.msn.com/id/16893833/site/newsweek/
WEB EXCLUSIVE
Should Schools Conduct Random Drug Tests?
The White House wants more schools to adopt random student drug-testing programs. NEWSWEEK talks to advocates on both sides of the issue.
By Alexandra Gekas Newsweek Jan. 30, 2007
The White House Office of National Drug Control Policy announced last week that it will be holding four regional summits promoting random student drug testing in public middle and high schools. The controversial program, which has already been implemented in nearly 1,000 middle and high schools across the country, requires that kids submit to random drug testing if they want to participate in competitive extracurricular activities like athletics. The Department of Education offers grants to schools that want to develop or expand a drug-testing programs for children in grades 6-12, but decisions about whether to test and which drugs to test for are made on an individual school level. The testing is usually done by a school nurse with a urine sample taken on school premises. If there's a positive result, the sample is sent out for verification by a lab. Tests can also be done with blood or saliva. Samples are generally tested for cocaine, marijuana, ecstasy, opium-based substances, oxycontin and, in some cases, steroids.
The proposed expansion of the program has prompted fierce debate and raised both privacy and efficacy questions. NEWSWEEK's Alexandra Gekas spoke with advocates on both sides of the issue: Dr. Bertha Madras, the deputy director of Demand Reduction in the ONDCP, which coordinates and promotes President Bush's drug prevention and treatment initiatives; and Jennifer Kern, a research associate with the Drug Policy Alliance, a group opposed to the program. (The interviews were conducted separately, but we've presented the participants' answers side by side.) Excerpts:
NEWSWEEK: How does student drug testing work? Dr. Bertha Madras: Under ideal conditions the testing is random, which is critical. If it's a urine test, the child is asked to come down to the nurse's office. They walk in solo, they deposit a sample as they would in any doctor's office, they give the sample to the nurse who puts a little dip stick in, and the dip stick will say positive or negative.
Jennifer Kern: They are removed from their classrooms and are escorted to take a drug test, and if they end up with a positive test result they are removed from their extracurricular activity. And because this is a very public removal from the classroom and often a public removal from the extracurricular activity, the testing is not as confidential as promised.
Is there a standard model for schools to follow when implementing the random testing? Madras: Schools have done it voluntarily without any federal assistance for a number of years since the 1990s. Once the Supreme Court weighed in, then it became more of a formalized procedure on how you do it and how you develop policies. [In 2002, the Supreme Court ruled that random drug testing of students participating in extracurricular activities does not violate the Constitution.] When grants became available in the Department of Education, then there were guidelines on how to do it.
Kern: There are model policies that are put out, but there is no legislation or guidelines for schools beyond the Supreme Court decision. [Schools] are not allowed to use the test results in certain ways legally, but in terms of how it is implemented, it varies. For some schools there's no verification on the type of labs they're using so there's a lot of concern that schools are using labs that are not certified or they are using their own staff. No protocol on how schools have to do it exists, so there is concern about schools not knowing what to do, leading to breaches of confidentiality and false positives.
Is anyone monitoring the schools to make sure they are doing it correctly? Madras: For the federal grants, there are project officers who keep in touch with the schools to see if they're going well. So when it's a federal program there clearly is oversight of the grant. If it's a grass-roots program, of which there are many in the country, then the monitoring is self-monitoring by the schools themselves. The critical thing to bear in mind with this program is the confidential nature of the information.
Kern: There's no outside monitoring. There's no regulation and there's no check or balance. While some schools describe the program as non-punitive, some schools have very harsh repercussions as far as removing kids from their extracurricular activities for the rest of the year or the rest of their school career. Some schools provide counseling but some provide no services to the students if they test positive. In a lot of places there isn't much money and there aren't many resources for students who test positive.
What are the penalties or repercussions for positive tests? Madras: The first repercussion is that the parents are called in and they're told that there is a positive test and we'd like to get help for the child. We can recommend a medical review officer who can go over what the test means and who can provide counseling. Sometimes the counseling is quick because it appears that the problem is not a profound one. At some schools there's no other repercussions in regard to their extracurricular activities, and in some schools the child is not allowed to play competitively for a period of time, but they can continue to practice with the team.
Kern: It's determined by the local school district, so typically it is suspension from an extracurricular activity, although I don't believe they are allowed to punish them in a way that would cause them to not be able to finish their education. Sometimes it can be very harsh and the concern is that extracurricular activities have been proven to keep students engaged and in school during the peak drug hours of 3 p.m. to 6 p.m., when parents are not home.
Is there a risk that kids who test positive for drugs will be stigmatized? Madras: The thing that I have heard is that everyone knows who's using drugs; there are no surprises amongst the kids. Kids know who are the users, their friends know, so when a kid is not engaged in sports for one game, nobody is surprised. I've been a parent all my life, and I knew which one of the kids I didn't want my kids near. I think the far greater risk is using the drug that can have adverse consequences on brain, body and behavior.
Kern: What is the point of removing the kids from extracurricular activities when they are most in need of that support and there is the question of confidentiality and those students being labeled as the 'bad kid' and how that effects them?
The ONDCP cites a random drug-testing program that was put in place for the military more than 20 years ago as evidence that testing can be effective in reducing drug use.
Madras: When the military began random mandatory testing the tests were 27 percent positive and now they are 1.5 percent. It didn't disappear in one year or two or five, but it declined very steeply and it's been steady for years.
Kern: Military testing has been in place, but some people coming back from certain situations certainly do continue to have substance-abuse problems.
Should a program from the military be applied to kids? Madras: I think it's very relevant because what you know is that behavioral modification is always a hybrid of positive and negative reinforcement. If you have a policy that says that drugs are not good for people then you institute a way of trying to modify behavior. The military did it just by random drug testing with consequence, and the same random testing in schools with very, very gentle outcomes or consequences, which are really targeted for the benefit of the child and not for the benefit of the school. And this is a way of enlisting the parents and saying we have to help this child. The deterrent factor in the schools is different than in the military. For the kids, one of the things that deter them is that they don't want to disappoint their parents.
Kern: People who elect to be in the military are going to be very different from people who need to be in high school and they are going to be at very different developmental stages in life, so how drugs affect them are going to be very different. Random drug testing has not been proven to deter drug use. In 2003, the National Institute on Drug Abuse funded the largest study ever conducted on the topic, and the Robert Wood Johnson Foundation backed it up with a second study that same year. Seasoned researchers compared a total of 94,000 students in almost 900 American schools with and without a drug-testing program, and found no differences in illegal drug use among students from both sets of schools.
What kind of a message are we sending to kids by saying that we don't trust them when they tell us they aren't doing drugs?
Madras: I don't think there's a negative message. When I go to schools that have the federal grant they say, "We love it! It gives me an excuse not to use at parties because kids are always pushing on us," but none of them say they're angry with the school. What I've heard above all is "thank you."
Kern: They are undermining the very protective factors that are shown to keep people out of trouble with drugs. For instance, [there are] concerns that the testing breaks down relationships of trust between students and adults at school, hinders open communication and contributes to a hostile school environment and it risks deterring students from extracurricular activities.
Is mandatory drug testing a violation of a student's right to privacy? Madras: I think that privacy issues are really interesting for adolescents. If a child is doing something that is illegal, then how do we weigh the more important value, which is how to protect a child? Really, ask yourself logically, do you feel young people who don't have a fully developed sense of self should be able to do things that are illegal to harm themselves?
Kern: [Drug testing ] is only for students who participate in extracurricular activities because the Supreme Court ruled it is permissible to [test] students in those activities because it described them as a privilege. But students in those programs are shown to have fewer problems with drugs so there is concern that it will deter kids from participating in those activities, which help kids feel connected and engaged with school. The Supreme Court decision is treating students like they are guilty until proven innocent.
-------------
entire article:
http://pediatrics.aappublications.org/cgi/reprint/119/3/627
short statement:
http://pediatrics.aappublications.org/cgi/content/short/119/3/627
PEDIATRICS Vol. 119 No. 3 March 2007, pp. 627-630
POLICY STATEMENT
Testing for Drugs of Abuse in Children and Adolescents: Addendum—Testing in Schools and at Home
Committee on Substance Abuse and Council on School Health
The American Academy of Pediatrics continues to believe that adolescents should not be drug tested without their knowledge and consent.
Recent US Supreme Court decisions and market forces have resulted in recommendations for drug testing of adolescents at school and products for parents to use to test adolescents at home.
The American Academy of Pediatrics has strong reservations about testing adolescents at school or at home and believes that more research is needed on both safety and efficacy before school-based testing programs are implemented.
The American Academy of Pediatrics also believes that more adolescent-specific substance abuse treatment resources are needed to ensure that testing leads to early rehabilitation rather than to punitive measures only.
Many of you will recall that Bertha Madras left the bench (at Harvard) two years ago to go work for ONDCP. Here's an interview with her (sparring with a rep from DPA) on the issue of student drug testing.
After the interview article, there is the statement of the American Academy of Pediatrics on student drug testing.
----------
http://www.msnbc.msn.com/id/16893833/site/newsweek/
WEB EXCLUSIVE
Should Schools Conduct Random Drug Tests?
The White House wants more schools to adopt random student drug-testing programs. NEWSWEEK talks to advocates on both sides of the issue.
By Alexandra Gekas Newsweek Jan. 30, 2007
The White House Office of National Drug Control Policy announced last week that it will be holding four regional summits promoting random student drug testing in public middle and high schools. The controversial program, which has already been implemented in nearly 1,000 middle and high schools across the country, requires that kids submit to random drug testing if they want to participate in competitive extracurricular activities like athletics. The Department of Education offers grants to schools that want to develop or expand a drug-testing programs for children in grades 6-12, but decisions about whether to test and which drugs to test for are made on an individual school level. The testing is usually done by a school nurse with a urine sample taken on school premises. If there's a positive result, the sample is sent out for verification by a lab. Tests can also be done with blood or saliva. Samples are generally tested for cocaine, marijuana, ecstasy, opium-based substances, oxycontin and, in some cases, steroids.
The proposed expansion of the program has prompted fierce debate and raised both privacy and efficacy questions. NEWSWEEK's Alexandra Gekas spoke with advocates on both sides of the issue: Dr. Bertha Madras, the deputy director of Demand Reduction in the ONDCP, which coordinates and promotes President Bush's drug prevention and treatment initiatives; and Jennifer Kern, a research associate with the Drug Policy Alliance, a group opposed to the program. (The interviews were conducted separately, but we've presented the participants' answers side by side.) Excerpts:
NEWSWEEK: How does student drug testing work? Dr. Bertha Madras: Under ideal conditions the testing is random, which is critical. If it's a urine test, the child is asked to come down to the nurse's office. They walk in solo, they deposit a sample as they would in any doctor's office, they give the sample to the nurse who puts a little dip stick in, and the dip stick will say positive or negative.
Jennifer Kern: They are removed from their classrooms and are escorted to take a drug test, and if they end up with a positive test result they are removed from their extracurricular activity. And because this is a very public removal from the classroom and often a public removal from the extracurricular activity, the testing is not as confidential as promised.
Is there a standard model for schools to follow when implementing the random testing? Madras: Schools have done it voluntarily without any federal assistance for a number of years since the 1990s. Once the Supreme Court weighed in, then it became more of a formalized procedure on how you do it and how you develop policies. [In 2002, the Supreme Court ruled that random drug testing of students participating in extracurricular activities does not violate the Constitution.] When grants became available in the Department of Education, then there were guidelines on how to do it.
Kern: There are model policies that are put out, but there is no legislation or guidelines for schools beyond the Supreme Court decision. [Schools] are not allowed to use the test results in certain ways legally, but in terms of how it is implemented, it varies. For some schools there's no verification on the type of labs they're using so there's a lot of concern that schools are using labs that are not certified or they are using their own staff. No protocol on how schools have to do it exists, so there is concern about schools not knowing what to do, leading to breaches of confidentiality and false positives.
Is anyone monitoring the schools to make sure they are doing it correctly? Madras: For the federal grants, there are project officers who keep in touch with the schools to see if they're going well. So when it's a federal program there clearly is oversight of the grant. If it's a grass-roots program, of which there are many in the country, then the monitoring is self-monitoring by the schools themselves. The critical thing to bear in mind with this program is the confidential nature of the information.
Kern: There's no outside monitoring. There's no regulation and there's no check or balance. While some schools describe the program as non-punitive, some schools have very harsh repercussions as far as removing kids from their extracurricular activities for the rest of the year or the rest of their school career. Some schools provide counseling but some provide no services to the students if they test positive. In a lot of places there isn't much money and there aren't many resources for students who test positive.
What are the penalties or repercussions for positive tests? Madras: The first repercussion is that the parents are called in and they're told that there is a positive test and we'd like to get help for the child. We can recommend a medical review officer who can go over what the test means and who can provide counseling. Sometimes the counseling is quick because it appears that the problem is not a profound one. At some schools there's no other repercussions in regard to their extracurricular activities, and in some schools the child is not allowed to play competitively for a period of time, but they can continue to practice with the team.
Kern: It's determined by the local school district, so typically it is suspension from an extracurricular activity, although I don't believe they are allowed to punish them in a way that would cause them to not be able to finish their education. Sometimes it can be very harsh and the concern is that extracurricular activities have been proven to keep students engaged and in school during the peak drug hours of 3 p.m. to 6 p.m., when parents are not home.
Is there a risk that kids who test positive for drugs will be stigmatized? Madras: The thing that I have heard is that everyone knows who's using drugs; there are no surprises amongst the kids. Kids know who are the users, their friends know, so when a kid is not engaged in sports for one game, nobody is surprised. I've been a parent all my life, and I knew which one of the kids I didn't want my kids near. I think the far greater risk is using the drug that can have adverse consequences on brain, body and behavior.
Kern: What is the point of removing the kids from extracurricular activities when they are most in need of that support and there is the question of confidentiality and those students being labeled as the 'bad kid' and how that effects them?
The ONDCP cites a random drug-testing program that was put in place for the military more than 20 years ago as evidence that testing can be effective in reducing drug use.
Madras: When the military began random mandatory testing the tests were 27 percent positive and now they are 1.5 percent. It didn't disappear in one year or two or five, but it declined very steeply and it's been steady for years.
Kern: Military testing has been in place, but some people coming back from certain situations certainly do continue to have substance-abuse problems.
Should a program from the military be applied to kids? Madras: I think it's very relevant because what you know is that behavioral modification is always a hybrid of positive and negative reinforcement. If you have a policy that says that drugs are not good for people then you institute a way of trying to modify behavior. The military did it just by random drug testing with consequence, and the same random testing in schools with very, very gentle outcomes or consequences, which are really targeted for the benefit of the child and not for the benefit of the school. And this is a way of enlisting the parents and saying we have to help this child. The deterrent factor in the schools is different than in the military. For the kids, one of the things that deter them is that they don't want to disappoint their parents.
Kern: People who elect to be in the military are going to be very different from people who need to be in high school and they are going to be at very different developmental stages in life, so how drugs affect them are going to be very different. Random drug testing has not been proven to deter drug use. In 2003, the National Institute on Drug Abuse funded the largest study ever conducted on the topic, and the Robert Wood Johnson Foundation backed it up with a second study that same year. Seasoned researchers compared a total of 94,000 students in almost 900 American schools with and without a drug-testing program, and found no differences in illegal drug use among students from both sets of schools.
What kind of a message are we sending to kids by saying that we don't trust them when they tell us they aren't doing drugs?
Madras: I don't think there's a negative message. When I go to schools that have the federal grant they say, "We love it! It gives me an excuse not to use at parties because kids are always pushing on us," but none of them say they're angry with the school. What I've heard above all is "thank you."
Kern: They are undermining the very protective factors that are shown to keep people out of trouble with drugs. For instance, [there are] concerns that the testing breaks down relationships of trust between students and adults at school, hinders open communication and contributes to a hostile school environment and it risks deterring students from extracurricular activities.
Is mandatory drug testing a violation of a student's right to privacy? Madras: I think that privacy issues are really interesting for adolescents. If a child is doing something that is illegal, then how do we weigh the more important value, which is how to protect a child? Really, ask yourself logically, do you feel young people who don't have a fully developed sense of self should be able to do things that are illegal to harm themselves?
Kern: [Drug testing ] is only for students who participate in extracurricular activities because the Supreme Court ruled it is permissible to [test] students in those activities because it described them as a privilege. But students in those programs are shown to have fewer problems with drugs so there is concern that it will deter kids from participating in those activities, which help kids feel connected and engaged with school. The Supreme Court decision is treating students like they are guilty until proven innocent.
-------------
entire article:
http://pediatrics.aappublications.org/cgi/reprint/119/3/627
short statement:
http://pediatrics.aappublications.org/cgi/content/short/119/3/627
PEDIATRICS Vol. 119 No. 3 March 2007, pp. 627-630
POLICY STATEMENT
Testing for Drugs of Abuse in Children and Adolescents: Addendum—Testing in Schools and at Home
Committee on Substance Abuse and Council on School Health
The American Academy of Pediatrics continues to believe that adolescents should not be drug tested without their knowledge and consent.
Recent US Supreme Court decisions and market forces have resulted in recommendations for drug testing of adolescents at school and products for parents to use to test adolescents at home.
The American Academy of Pediatrics has strong reservations about testing adolescents at school or at home and believes that more research is needed on both safety and efficacy before school-based testing programs are implemented.
The American Academy of Pediatrics also believes that more adolescent-specific substance abuse treatment resources are needed to ensure that testing leads to early rehabilitation rather than to punitive measures only.
Two papers on MDMA psychotherapy
Two papers on MDMA psychotherapy
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17329304&query_hl=8&itool=pubmed_docsum
J Psychopharmacol. 2007 Mar;21(2):220-4.
Is there a case for MDMA-assisted psychotherapy in the UK?
Sessa B. Psychopharmacology Unit, Dorothy Hodgkin Building, Bristol, UK.
ABSTRACT
Much has been written in scientific and popular literature in recent years about the dangers surrounding the recreational use of the drug MDMA/ecstasy.
What is little known and understood however is the history of the apparently safe and effective use of MDMA as a therapeutic tool for psychotherapy.
In this paper the author explores this history and describes the recent re-emergence of scientific interest in MDMA and other psychedelic drugs.
There are currently several new double-blind randomised controlled trials underway re-visiting the subject.
By acknowledging the limitations of this new research and emphasising the importance of exercising appropriate but realistic caution, the author asks that the medical profession consider a dispassionate and open-minded debate to examine whether MDMA might have a legitimate place as an adjunct to psychotherapy in modern psychiatric practice.
----
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17297639&query_hl=8&itool=pubmed_docsum
Psychopharmacology (Berl). 2007 Apr;191(2):181-93. Epub 2007 Feb 13
The psychotherapeutic potential of MDMA (3,4-methylenedioxymethamphetamine): an evidence-based review.
Parrott AC. Department of Psychology, University of Wales Swansea, Swansea, SA2 8PP, Wales, UK, a.c.parrott@swansea.ac.uk.
ABSTRACT
AIMS AND RATIONALE: The purpose of this study was to review whether methylenedioxy-methamphetamine (MDMA) has the appropriate pharmacodynamic profile to be a therapeutic agent.
MATERIALS AND METHODS: Empirical descriptions of MDMA's subjective effects in humans will be reviewed to evaluate the proposal that MDMA has psychotherapeutic properties. The focus will be published evidence on its functional effects in therapeutic, medical, and other situations.
RESULTS: MDMA is a powerful central nervous system (CNS) stimulant which affects several neurotransmitter systems and intensifies a range of psychobiological functions. Its acute mood effects can be very positive and life enhancing, and the affirmative cognitions engendered during MDMA therapy may well endure afterwards.
However, MDMA also has a number of potential anti-therapeutic characteristics. Acutely, it can also intensify negative cognitions, and these may similarly endure over time. Psychotherapists have found that setting, intention, and expectancy are crucial for a positive outcome, but these factors cannot be guaranteed. Post-MDMA, there is a period of neurotransmitter recovery when low moods predominate, and these may exacerbate psychiatric distress.
The explanations proposed for MDMA-assisted therapy are all psychodynamic, and a neurochemical model needs to be outlined. It has been suggested that enduring therapeutic gains can follow a single session, but again, this lacks a clear psychopharmacological rationale.
Finally, diathesis-stress models suggest that psychiatric individuals are more prone to acute and chronic abreactions to CNS stimulants such as MDMA.
CONCLUSIONS: There are a number of issues which need to be addressed before it can be argued that MDMA might be clinically useful for psychotherapy.Parrott AC.
Department of Psychology, University of Wales Swansea, Swansea, SA2 8PP, Wales,
UK, a.c.parrott@swansea.ac.uk.
ABSTRACT
AIMS AND RATIONALE: The purpose of this study was to review whether methylenedioxy-methamphetamine (MDMA) has the appropriate pharmacodynamic profile to be a therapeutic agent.
MATERIALS AND METHODS: Empirical descriptions of MDMA's subjective effects in humans will be reviewed to evaluate the proposal that MDMA has psychotherapeutic properties. The focus will be published evidence on its functional effects in therapeutic, medical, and other situations.
RESULTS: MDMA is a powerful central nervous system (CNS) stimulant which affects several neurotransmitter systems and intensifies a range of psychobiological functions. Its acute mood effects can be very positive and life enhancing, and the affirmative cognitions engendered during MDMA therapy may well endure afterwards.
However, MDMA also has a number of potential anti-therapeutic characteristics. Acutely, it can also intensify negative cognitions, and these may similarly endure over time. Psychotherapists have found that setting, intention, and expectancy are crucial for a positive outcome, but these factors cannot be guaranteed. Post-MDMA, there is a period of neurotransmitter recovery when low moods predominate, and these may exacerbate psychiatric distress.
The explanations proposed for MDMA-assisted therapy are all psychodynamic, and a neurochemical model needs to be outlined. It has been suggested that enduring therapeutic gains can follow a single session, but again, this lacks a clear psychopharmacological rationale.
Finally, diathesis-stress models suggest that psychiatric individuals are more prone to acute and chronic abreactions to CNS stimulants such as MDMA.
CONCLUSIONS: There are a number of issues which need to be addressed before it can be argued that MDMA might be clinically useful for psychotherapy.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17329304&query_hl=8&itool=pubmed_docsum
J Psychopharmacol. 2007 Mar;21(2):220-4.
Is there a case for MDMA-assisted psychotherapy in the UK?
Sessa B. Psychopharmacology Unit, Dorothy Hodgkin Building, Bristol, UK.
ABSTRACT
Much has been written in scientific and popular literature in recent years about the dangers surrounding the recreational use of the drug MDMA/ecstasy.
What is little known and understood however is the history of the apparently safe and effective use of MDMA as a therapeutic tool for psychotherapy.
In this paper the author explores this history and describes the recent re-emergence of scientific interest in MDMA and other psychedelic drugs.
There are currently several new double-blind randomised controlled trials underway re-visiting the subject.
By acknowledging the limitations of this new research and emphasising the importance of exercising appropriate but realistic caution, the author asks that the medical profession consider a dispassionate and open-minded debate to examine whether MDMA might have a legitimate place as an adjunct to psychotherapy in modern psychiatric practice.
----
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17297639&query_hl=8&itool=pubmed_docsum
Psychopharmacology (Berl). 2007 Apr;191(2):181-93. Epub 2007 Feb 13
The psychotherapeutic potential of MDMA (3,4-methylenedioxymethamphetamine): an evidence-based review.
Parrott AC. Department of Psychology, University of Wales Swansea, Swansea, SA2 8PP, Wales, UK, a.c.parrott@swansea.ac.uk.
ABSTRACT
AIMS AND RATIONALE: The purpose of this study was to review whether methylenedioxy-methamphetamine (MDMA) has the appropriate pharmacodynamic profile to be a therapeutic agent.
MATERIALS AND METHODS: Empirical descriptions of MDMA's subjective effects in humans will be reviewed to evaluate the proposal that MDMA has psychotherapeutic properties. The focus will be published evidence on its functional effects in therapeutic, medical, and other situations.
RESULTS: MDMA is a powerful central nervous system (CNS) stimulant which affects several neurotransmitter systems and intensifies a range of psychobiological functions. Its acute mood effects can be very positive and life enhancing, and the affirmative cognitions engendered during MDMA therapy may well endure afterwards.
However, MDMA also has a number of potential anti-therapeutic characteristics. Acutely, it can also intensify negative cognitions, and these may similarly endure over time. Psychotherapists have found that setting, intention, and expectancy are crucial for a positive outcome, but these factors cannot be guaranteed. Post-MDMA, there is a period of neurotransmitter recovery when low moods predominate, and these may exacerbate psychiatric distress.
The explanations proposed for MDMA-assisted therapy are all psychodynamic, and a neurochemical model needs to be outlined. It has been suggested that enduring therapeutic gains can follow a single session, but again, this lacks a clear psychopharmacological rationale.
Finally, diathesis-stress models suggest that psychiatric individuals are more prone to acute and chronic abreactions to CNS stimulants such as MDMA.
CONCLUSIONS: There are a number of issues which need to be addressed before it can be argued that MDMA might be clinically useful for psychotherapy.Parrott AC.
Department of Psychology, University of Wales Swansea, Swansea, SA2 8PP, Wales,
UK, a.c.parrott@swansea.ac.uk.
ABSTRACT
AIMS AND RATIONALE: The purpose of this study was to review whether methylenedioxy-methamphetamine (MDMA) has the appropriate pharmacodynamic profile to be a therapeutic agent.
MATERIALS AND METHODS: Empirical descriptions of MDMA's subjective effects in humans will be reviewed to evaluate the proposal that MDMA has psychotherapeutic properties. The focus will be published evidence on its functional effects in therapeutic, medical, and other situations.
RESULTS: MDMA is a powerful central nervous system (CNS) stimulant which affects several neurotransmitter systems and intensifies a range of psychobiological functions. Its acute mood effects can be very positive and life enhancing, and the affirmative cognitions engendered during MDMA therapy may well endure afterwards.
However, MDMA also has a number of potential anti-therapeutic characteristics. Acutely, it can also intensify negative cognitions, and these may similarly endure over time. Psychotherapists have found that setting, intention, and expectancy are crucial for a positive outcome, but these factors cannot be guaranteed. Post-MDMA, there is a period of neurotransmitter recovery when low moods predominate, and these may exacerbate psychiatric distress.
The explanations proposed for MDMA-assisted therapy are all psychodynamic, and a neurochemical model needs to be outlined. It has been suggested that enduring therapeutic gains can follow a single session, but again, this lacks a clear psychopharmacological rationale.
Finally, diathesis-stress models suggest that psychiatric individuals are more prone to acute and chronic abreactions to CNS stimulants such as MDMA.
CONCLUSIONS: There are a number of issues which need to be addressed before it can be argued that MDMA might be clinically useful for psychotherapy.
Friday
Brain changes after first MDMA use
http://www.nature.com/npp/journal/v32/n2/full/1301225a.html
Neuropsychopharmacology (2007) 32, 458–470.
A Prospective Cohort Study on Sustained Effects of Low-Dose Ecstasy Use on the Brain in New Ecstasy Users
Maartje M L de Win, Liesbeth Reneman, Gerry Jager, Erik-Jan P Vlieger, SÃlvia D Olabarriaga, Cristina Lavini, Ivo Bisschops, Charles B L M Majoie, Jan Booij, Gerard J den Heeten and Wim van den Brink
Abstract
It is debated whether ecstasy use has neurotoxic effects on the human brain and what the effects are of a low dose of ecstasy use.
We prospectively studied sustained effects (>2 weeks abstinence) of a low dose of ecstasy on the brain in ecstasy-naive volunteers using a combination of advanced MR techniques and self-report questionnaires on psychopathology as part of the NeXT (Netherlands XTC Toxicity) study.
Outcomes of proton magnetic resonance spectroscopy (1H-MRS), diffusion tensor imaging (DTI), perfusion-weighted imaging (PWI), and questionnaires on depression, impulsivity, and sensation seeking were compared in 30 subjects (12M, 21.8 +/- 3.1 years) in two sessions before and after first ecstasy use (1.8 +/- 1.3 tablets).
Interval between baseline and follow-up was on average 8.1 +/- 6.5 months and time between last ecstasy use and follow-up was 7.7 +/- 4.4 weeks.
Using 1H-MRS, no significant changes were observed in metabolite concentrations of N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI), and creatine (Cr), nor in ratios of NAA, Cho, and mI relative to Cr.
However, ecstasy use was followed by a sustained 0.9% increase in fractional anisotropy (FA) in frontoparietal white matter, a 3.4% decrease in apparent diffusion (ADC) in the thalamus and a sustained decrease in relative regional cerebral blood volume (rrCBV) in the thalamus (-6.2%), dorsolateral frontal cortex (-4.0%), and superior parietal cortex (-3.0%) (all significant at p<0.05, paired t-tests).
After correction for multiple comparisons, only the rrCBV decrease in the dorsolateral frontal cortex remained significant.
We also observed increased impulsivity (+3.7% on the Barratt Impulsiveness Scale) and decreased depression (-28.0% on the Beck Depression Inventory) in novel ecstasy users, although effect sizes were limited and clinical relevance questionable.
As no indications were found for structural neuronal damage with the currently used techniques, our data do not support the concern that incidental ecstasy use leads to extensive axonal damage.
However, sustained decreases in rrCBV and ADC values may indicate that even low ecstasy doses can induce prolonged vasoconstriction in some brain areas, although it is not known whether this effect is permanent. Additional studies are needed to replicate these findings.
Neuropsychopharmacology (2007) 32, 458–470.
A Prospective Cohort Study on Sustained Effects of Low-Dose Ecstasy Use on the Brain in New Ecstasy Users
Maartje M L de Win, Liesbeth Reneman, Gerry Jager, Erik-Jan P Vlieger, SÃlvia D Olabarriaga, Cristina Lavini, Ivo Bisschops, Charles B L M Majoie, Jan Booij, Gerard J den Heeten and Wim van den Brink
Abstract
It is debated whether ecstasy use has neurotoxic effects on the human brain and what the effects are of a low dose of ecstasy use.
We prospectively studied sustained effects (>2 weeks abstinence) of a low dose of ecstasy on the brain in ecstasy-naive volunteers using a combination of advanced MR techniques and self-report questionnaires on psychopathology as part of the NeXT (Netherlands XTC Toxicity) study.
Outcomes of proton magnetic resonance spectroscopy (1H-MRS), diffusion tensor imaging (DTI), perfusion-weighted imaging (PWI), and questionnaires on depression, impulsivity, and sensation seeking were compared in 30 subjects (12M, 21.8 +/- 3.1 years) in two sessions before and after first ecstasy use (1.8 +/- 1.3 tablets).
Interval between baseline and follow-up was on average 8.1 +/- 6.5 months and time between last ecstasy use and follow-up was 7.7 +/- 4.4 weeks.
Using 1H-MRS, no significant changes were observed in metabolite concentrations of N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI), and creatine (Cr), nor in ratios of NAA, Cho, and mI relative to Cr.
However, ecstasy use was followed by a sustained 0.9% increase in fractional anisotropy (FA) in frontoparietal white matter, a 3.4% decrease in apparent diffusion (ADC) in the thalamus and a sustained decrease in relative regional cerebral blood volume (rrCBV) in the thalamus (-6.2%), dorsolateral frontal cortex (-4.0%), and superior parietal cortex (-3.0%) (all significant at p<0.05, paired t-tests).
After correction for multiple comparisons, only the rrCBV decrease in the dorsolateral frontal cortex remained significant.
We also observed increased impulsivity (+3.7% on the Barratt Impulsiveness Scale) and decreased depression (-28.0% on the Beck Depression Inventory) in novel ecstasy users, although effect sizes were limited and clinical relevance questionable.
As no indications were found for structural neuronal damage with the currently used techniques, our data do not support the concern that incidental ecstasy use leads to extensive axonal damage.
However, sustained decreases in rrCBV and ADC values may indicate that even low ecstasy doses can induce prolonged vasoconstriction in some brain areas, although it is not known whether this effect is permanent. Additional studies are needed to replicate these findings.
UK drug data
http://image.guardian.co.uk/sys-files/Guardian/documents/2005/07/05/Report.pdf
A report on UK drug use from the British government, published by the Guardian newspaper.
Some very interesting takes on things. Like this, on page 2 of the summary:
"Even if supply side interventions were more effective, it is not clear that the impact on the harms caused by serious drug users would be reduced."
And on page 30, chart showing that individuals who abuse both heroin and crack commit 75% of all crime associated with these drugs.
See page 35 regarding comparable harms from drugs of abuse.
A report on UK drug use from the British government, published by the Guardian newspaper.
Some very interesting takes on things. Like this, on page 2 of the summary:
"Even if supply side interventions were more effective, it is not clear that the impact on the harms caused by serious drug users would be reduced."
And on page 30, chart showing that individuals who abuse both heroin and crack commit 75% of all crime associated with these drugs.
See page 35 regarding comparable harms from drugs of abuse.
Venom Abuse
The last sentence pretty much sums it up.
---------
http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2006;volume=52;issue=4;spage=325;epage=326;aulast=Varghese
J Postgrad Med 2006;52:325-326 Unconventional substances of abuse: Scorpions and lizards
Varghese ST, Balhara Y, Mondal A.
Sir,
Although it is common knowledge that many plants contain psychoactive substances, the fact that certain animals also do is barely known. The use of various insects as substances of abuse is interesting and has not been reported in detail in medical literature. We would like to illustrate two cases of animals used for their psychoactive properties and a brief review is provided.
A 60-year-old man with a 35-year history of heroin dependence was admitted for detoxification. On detailed evaluation the patient admitted to using scorpions on many occasions when heroin was not available. He described a distinct pleasurable effect of the sting that was more potent than heroin. He experienced an instant rush and would feel relaxed and would be under its effects for almost six hours. The patient used to collect the scorpions from the crevices in the rocks and would make it sting his hands before disposing them. He did not report any hallucinations or loss of consciousness any time during his sojourns.
A 35-year-old man with a 15-year history of heroin use was imprisoned for alleged illegal activities. While serving his term, the patient shifted his drug of use to lizards due to non-availability of heroin. He would catch lizards pull out their internal organs and burn them. He would later take the charred remains and fill them in a cigarette and inhale deeply. He claimed instant high on this substance and claimed it to be as pleasurable as heroin. On his release from the prison he continued using heroin. Both the patients were assessed for any psychopathology and did not have any co-morbid psychiatric illness.
Scorpion venom contains low molecular weight basic polypeptides, neurotoxins that are the principal toxic agents. These toxins act on ion channels, promoting a derangement that may result in an abnormal release of neuro-transmitters.[1] The release of serotonin caused by the poison may be the reason for the pleasurable feeling associated with the poison. The effects of poison on the sodium-potassium pumps in the nerves may also explain these effects. The acute effects of scorpion envenomation include extreme anxiety, pain at the bite site, acute renal failure, myocardial toxicity, left ventricular dysfunction and pulmonary edema.[2] Agitation, seizures, squint, miosis, mydriasis and coma are the acute neurological manifestations of toxicity.[3] Literature is sparse on the long-term effects of these toxins in humans.
Other creatures that have been used for their psycho-active properties include fish, wasps, toads, snakes and even human body parts.[4] Newspaper reports are available of rising scorpion sting use in Gujarat, India for their psychoactive properties. The practice of medicine is made interesting by these occasional cases and in addiction medicine some patients never fail to surprise you.
References
1. Nencioni AL, Carvalho FF, Lebrun I, Dorce VA, Sandoval MR. Neurotoxic effects of three fractions isolated from Tityus serrulatus scorpion venom. Pharmacol Toxicol 2000;86:149-55.
2. Rajasekhar D, Mohan A. Clinical and echocardiographic findings in patients with myocardial toxicity due to scorpion sting. Natl Med J India. 2004;17: 307-9.
3. Bahloul M, Rekik N, Chabchoub I, Chaari A, Ksibi H, Kallel H, et al . Neurological complications secondary to severe scorpion envenomation. Med Sci Monit 2005;11:196-202.
4. Rudgley R. The Encyclopedia of Psychoactive Substances. 1st ed. Little Brown and Co: Great Britain; 2000.
---------
http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2006;volume=52;issue=4;spage=325;epage=326;aulast=Varghese
J Postgrad Med 2006;52:325-326 Unconventional substances of abuse: Scorpions and lizards
Varghese ST, Balhara Y, Mondal A.
Sir,
Although it is common knowledge that many plants contain psychoactive substances, the fact that certain animals also do is barely known. The use of various insects as substances of abuse is interesting and has not been reported in detail in medical literature. We would like to illustrate two cases of animals used for their psychoactive properties and a brief review is provided.
A 60-year-old man with a 35-year history of heroin dependence was admitted for detoxification. On detailed evaluation the patient admitted to using scorpions on many occasions when heroin was not available. He described a distinct pleasurable effect of the sting that was more potent than heroin. He experienced an instant rush and would feel relaxed and would be under its effects for almost six hours. The patient used to collect the scorpions from the crevices in the rocks and would make it sting his hands before disposing them. He did not report any hallucinations or loss of consciousness any time during his sojourns.
A 35-year-old man with a 15-year history of heroin use was imprisoned for alleged illegal activities. While serving his term, the patient shifted his drug of use to lizards due to non-availability of heroin. He would catch lizards pull out their internal organs and burn them. He would later take the charred remains and fill them in a cigarette and inhale deeply. He claimed instant high on this substance and claimed it to be as pleasurable as heroin. On his release from the prison he continued using heroin. Both the patients were assessed for any psychopathology and did not have any co-morbid psychiatric illness.
Scorpion venom contains low molecular weight basic polypeptides, neurotoxins that are the principal toxic agents. These toxins act on ion channels, promoting a derangement that may result in an abnormal release of neuro-transmitters.[1] The release of serotonin caused by the poison may be the reason for the pleasurable feeling associated with the poison. The effects of poison on the sodium-potassium pumps in the nerves may also explain these effects. The acute effects of scorpion envenomation include extreme anxiety, pain at the bite site, acute renal failure, myocardial toxicity, left ventricular dysfunction and pulmonary edema.[2] Agitation, seizures, squint, miosis, mydriasis and coma are the acute neurological manifestations of toxicity.[3] Literature is sparse on the long-term effects of these toxins in humans.
Other creatures that have been used for their psycho-active properties include fish, wasps, toads, snakes and even human body parts.[4] Newspaper reports are available of rising scorpion sting use in Gujarat, India for their psychoactive properties. The practice of medicine is made interesting by these occasional cases and in addiction medicine some patients never fail to surprise you.
References
1. Nencioni AL, Carvalho FF, Lebrun I, Dorce VA, Sandoval MR. Neurotoxic effects of three fractions isolated from Tityus serrulatus scorpion venom. Pharmacol Toxicol 2000;86:149-55.
2. Rajasekhar D, Mohan A. Clinical and echocardiographic findings in patients with myocardial toxicity due to scorpion sting. Natl Med J India. 2004;17: 307-9.
3. Bahloul M, Rekik N, Chabchoub I, Chaari A, Ksibi H, Kallel H, et al . Neurological complications secondary to severe scorpion envenomation. Med Sci Monit 2005;11:196-202.
4. Rudgley R. The Encyclopedia of Psychoactive Substances. 1st ed. Little Brown and Co: Great Britain; 2000.
California's 1906 Pharmacy and Poison Act
http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/03/04/ING44OD4AU1.DTL&type=printable
CA 1906 Pharmacy and Poison Act
"State's war on drugs a 100-year-old bust
Rate of addiction has doubled since crackdown on use"
Dale Gieringer
Sunday, March 4, 2007
San Francisco Chronicle
Tuesday marks the centennial of a fateful but forgotten watershed in
state history: the start of California's war on drugs.
On March 6, 1907, Gov. James Gillett signed amendments to the Pharmacy
and Poison Act making it a crime to sell opiates or cocaine in the state
without a prescription. The act made California a national leader in the
war on drugs seven years before Congress enacted national drug
prohibition with the Harrison Act.
Many Americans don't know there was a time when people could freely buy
any drug they wanted, including opium, cocaine, cannabis and other
so-called narcotics. For most of the nation's history, there was no such
thing as an illegal drug. That began to change after the turn of the
20th century, when an alliance of Progressive Era bureaucrats and moral
crusaders began to push for prohibition of narcotics and alcohol.
California's law was engineered by the state Board of Pharmacy, a
national pioneer in drug enforcement whose exploits have been largely
lost to history. The board was established in 1891 to regulate
pharmacies and the sale of poisons. The 1891 law required that narcotics
carry warning labels and that their sales be recorded in a register, but
it did not restrict purchases.
However, a rising national tide for pure food and drug legislation
prompted the board to propose stronger measures to the Legislature. In
1907, the law was quietly amended without any press coverage or public
debate -- or any discussion of possible adverse effects. As soon as the
law took effect, the board began a high-profile enforcement campaign,
dispatching its agents from city to city, investigating and busting
offending pharmacists, raiding opium dens, and publicizing their arrests
in the newspapers.
The campaign proved to be the opening battle in a 100-year war that
still rages with no signs of ultimate victory.
California's anti-drug efforts go even further back. In 1875, San
Francisco passed the nation's first anti-drug law, the Opium Den
Ordinance, aimed specifically at Chinese opium smoking. Passed at the
height of anti-Chinese hysteria, the law was the legacy of the city's
shortest serving mayor, Dr. George Hewston, who was in office for a
month after the sudden death of Mayor James Otis.
Although the dens had been around for years, Hewston decried the
increase in dens "frequented by white males and females of various
ages," and called on the supervisors to suppress practices "which are
against good morals and contrary to public order." The ordinance did not
prohibit sale or private use of opium, but banned dens for public
smoking. Conscious that the city remained a lucrative center of the
opium trade, the supervisors went on to impose a license fee on opium
dealers, which the Chinese adeptly evaded.
For years, the dens continued to thrive underground, a lucrative
industry of vice and a source of bribery and corruption, like
prostitution and gambling. The Chinese were typically left alone, but
dens that catered to whites were considered fair game for law
enforcement.
Other cities began to ban the dens, and in 1881 the Legislature enacted
a statewide ban. Nonetheless, the dens persisted, as did anti-Chinese
sentiment, and stricter measures were proposed. Among them was an
opium-prohibition bill by state Sen. George Perry of San Francisco, that
managed to pass the 1885 Legislature but was vetoed.
The Perry bill would have banned sale of the drug except with a doctor's
prescription. Opponents charged it was secretly aimed at extracting a
bribe from the opium dealers to stop it -- charges that gained momentum
when the bill was obligingly vetoed by Gov. George Stoneman, a crony of
Perry's. The next session, another opium-prohibition bill was withdrawn
amid renewed charges of bribery. The Legislature finally washed its
hands of the matter by passing a resolution calling on Congress to act,
but there was little interest in Washington.
San Francisco enacted a pioneering anti-narcotics law of its own in
1889. The move came in response to a petition from the San Francisco
Medical Society, which, lamenting the ruination of the city's young men
and women by Chinese opium, called for sales to be restricted to
pharmacies and used for medical purposes only.
Meanwhile, the superintendent of the local House of Corrections reported
a disturbing influx of inmates who were addicted to the newly
popularized hypodermic use of morphine and cocaine. The supervisors
responded with one of the nation's first comprehensive anti-narcotics
laws, the Morphine/Cocaine Ordinance.
The ordinance, in effect a prototype of the 1907 law, banned the sale of
opium, morphine and cocaine except by pharmacies on a doctor's
prescription. Ironically for a city destined to become the mecca of the
1960s drug culture, the ordinance specifically forbade recreational use,
disallowing prescriptions for the purpose of satisfying "curiosity or to
experience any of the sensations produced thereby."
The ordinance proved unsuccessful. It faced significant opposition from
the city's druggists, who objected to the hardship of requiring
suffering patients to get a doctor's prescription. An initial flurry of
arrests drove the drug fiends to Oakland, which in turn passed its own
law.
However, enforcement efforts soon lagged, as police were reluctant to
hassle otherwise peaceable pharmacists. By 1893, The Chronicle declared
the ordinance a "dead letter."
California's war on drugs began in earnest with the 1907 amendments. The
Board of Pharmacy launched an aggressive campaign and pioneered the
modern tactics of drug enforcement. The board hired undercover agents
who posed as suffering patients, wheedling drugs from unsuspecting
pharmacists, then arresting them.
The board swept down on the Chinatown dens, busting down doors and
arresting hundreds. It strategically expanded its powers through new
legislation. In a crucial move, possession was outlawed in 1909. This
set the stage for the criminalization of users, today the largest single
class of criminals in California.
The board also moved to ban possession of opium pipes. It then garnered
headlines by staging gigantic public bonfires of confiscated
paraphernalia and drugs in the heart of Chinatown.
The raids broke the back of the opium-smoking culture, but the addicts
moved on to morphine and heroin. The board proceeded to launch a
pre-emptive attack on "Indian hemp" or cannabis in 1913.
At the time, cannabis was virtually unheard of in California.
Nonetheless, the board warned of an influx of cannabis-using "Hindoos"
(actually Sikhs) from India, and prevailed on the Legislature to ban the
drug lest the habit spread to whites. Ironically, only after being
outlawed did marijuana become popular, eventually being used by millions
of Californians.
To a public unaccustomed to drug enforcement, the board's conduct
initially stirred consternation. The public "has been disgusted with the
sending of spies and stool-pigeons to gather evidence," the Santa Cruz
News said in an editorial. Board inspectors were accused of brutal
beatings and violence of a kind unknown in pre-prohibition days.
Inevitably, corruption also ensued. The board's chief inspector,
Frederick Sutherland, was fired amid allegations of bribery after he
married a drug-dealing widow.
In subsequent years, attitudes hardened. As black market dealers moved
in, drugs were increasingly viewed as a criminal problem. At first,
penalties were relatively mild: Sale was classified as only a
misdemeanor. Later, possession became punishable by up to six years in
prison. Originally, the board had envisioned that drug fiends would be
treated in asylums rather than sent to jail. However, funding for
asylums was repeatedly vetoed, sending addicts to prison.
As the screws tightened, the problem got worse. Federal and state laws
forced prices out of sight, pushing addicts into crime. By 1919, the Los
Angeles Times reported a "saturnalia of violent crime" caused by drug
fiends desperate to get narcotics. Stories of drug crime and violence,
rarely seen before prohibition, became a staple item in the press.
In the end, the drug laws became a giant crime-creation program.
Before 1907, the state's drug crime involved a few hundred opium den
misdemeanors. Today, the state records 400,000 drug arrests per year,
250,000 of them felonies. Drug felons -- nonexistent in 1906 -- now
account for 36,000 prisoners, 20 percent of the state's prison
population. Drug gangs plague our cities, thousands of innocent people
are victimized by prohibition-related theft and violence, and the rough
stuff has escalated into outright war in Afghanistan, Colombia and
Mexico.
Today's addiction rate is more than twice what existed during the free
market a century ago -- only about one-half percent.
After 100 years, it is hard to escape the conclusion that drug
prohibition has failed. In recent years, Californians have begun to show
second thoughts, approving initiatives to re-legalize medical cannabis
and to send drug users for treatment rather than to prison. As the state
with the longest historical experience with drug laws, it is fitting
that California should be exploring new directions out of its 100-year
war on drugs.
Dale Gieringer is California director of NORML. Contact us at
insight@sfchronicle.com.
CA 1906 Pharmacy and Poison Act
"State's war on drugs a 100-year-old bust
Rate of addiction has doubled since crackdown on use"
Dale Gieringer
Sunday, March 4, 2007
San Francisco Chronicle
Tuesday marks the centennial of a fateful but forgotten watershed in
state history: the start of California's war on drugs.
On March 6, 1907, Gov. James Gillett signed amendments to the Pharmacy
and Poison Act making it a crime to sell opiates or cocaine in the state
without a prescription. The act made California a national leader in the
war on drugs seven years before Congress enacted national drug
prohibition with the Harrison Act.
Many Americans don't know there was a time when people could freely buy
any drug they wanted, including opium, cocaine, cannabis and other
so-called narcotics. For most of the nation's history, there was no such
thing as an illegal drug. That began to change after the turn of the
20th century, when an alliance of Progressive Era bureaucrats and moral
crusaders began to push for prohibition of narcotics and alcohol.
California's law was engineered by the state Board of Pharmacy, a
national pioneer in drug enforcement whose exploits have been largely
lost to history. The board was established in 1891 to regulate
pharmacies and the sale of poisons. The 1891 law required that narcotics
carry warning labels and that their sales be recorded in a register, but
it did not restrict purchases.
However, a rising national tide for pure food and drug legislation
prompted the board to propose stronger measures to the Legislature. In
1907, the law was quietly amended without any press coverage or public
debate -- or any discussion of possible adverse effects. As soon as the
law took effect, the board began a high-profile enforcement campaign,
dispatching its agents from city to city, investigating and busting
offending pharmacists, raiding opium dens, and publicizing their arrests
in the newspapers.
The campaign proved to be the opening battle in a 100-year war that
still rages with no signs of ultimate victory.
California's anti-drug efforts go even further back. In 1875, San
Francisco passed the nation's first anti-drug law, the Opium Den
Ordinance, aimed specifically at Chinese opium smoking. Passed at the
height of anti-Chinese hysteria, the law was the legacy of the city's
shortest serving mayor, Dr. George Hewston, who was in office for a
month after the sudden death of Mayor James Otis.
Although the dens had been around for years, Hewston decried the
increase in dens "frequented by white males and females of various
ages," and called on the supervisors to suppress practices "which are
against good morals and contrary to public order." The ordinance did not
prohibit sale or private use of opium, but banned dens for public
smoking. Conscious that the city remained a lucrative center of the
opium trade, the supervisors went on to impose a license fee on opium
dealers, which the Chinese adeptly evaded.
For years, the dens continued to thrive underground, a lucrative
industry of vice and a source of bribery and corruption, like
prostitution and gambling. The Chinese were typically left alone, but
dens that catered to whites were considered fair game for law
enforcement.
Other cities began to ban the dens, and in 1881 the Legislature enacted
a statewide ban. Nonetheless, the dens persisted, as did anti-Chinese
sentiment, and stricter measures were proposed. Among them was an
opium-prohibition bill by state Sen. George Perry of San Francisco, that
managed to pass the 1885 Legislature but was vetoed.
The Perry bill would have banned sale of the drug except with a doctor's
prescription. Opponents charged it was secretly aimed at extracting a
bribe from the opium dealers to stop it -- charges that gained momentum
when the bill was obligingly vetoed by Gov. George Stoneman, a crony of
Perry's. The next session, another opium-prohibition bill was withdrawn
amid renewed charges of bribery. The Legislature finally washed its
hands of the matter by passing a resolution calling on Congress to act,
but there was little interest in Washington.
San Francisco enacted a pioneering anti-narcotics law of its own in
1889. The move came in response to a petition from the San Francisco
Medical Society, which, lamenting the ruination of the city's young men
and women by Chinese opium, called for sales to be restricted to
pharmacies and used for medical purposes only.
Meanwhile, the superintendent of the local House of Corrections reported
a disturbing influx of inmates who were addicted to the newly
popularized hypodermic use of morphine and cocaine. The supervisors
responded with one of the nation's first comprehensive anti-narcotics
laws, the Morphine/Cocaine Ordinance.
The ordinance, in effect a prototype of the 1907 law, banned the sale of
opium, morphine and cocaine except by pharmacies on a doctor's
prescription. Ironically for a city destined to become the mecca of the
1960s drug culture, the ordinance specifically forbade recreational use,
disallowing prescriptions for the purpose of satisfying "curiosity or to
experience any of the sensations produced thereby."
The ordinance proved unsuccessful. It faced significant opposition from
the city's druggists, who objected to the hardship of requiring
suffering patients to get a doctor's prescription. An initial flurry of
arrests drove the drug fiends to Oakland, which in turn passed its own
law.
However, enforcement efforts soon lagged, as police were reluctant to
hassle otherwise peaceable pharmacists. By 1893, The Chronicle declared
the ordinance a "dead letter."
California's war on drugs began in earnest with the 1907 amendments. The
Board of Pharmacy launched an aggressive campaign and pioneered the
modern tactics of drug enforcement. The board hired undercover agents
who posed as suffering patients, wheedling drugs from unsuspecting
pharmacists, then arresting them.
The board swept down on the Chinatown dens, busting down doors and
arresting hundreds. It strategically expanded its powers through new
legislation. In a crucial move, possession was outlawed in 1909. This
set the stage for the criminalization of users, today the largest single
class of criminals in California.
The board also moved to ban possession of opium pipes. It then garnered
headlines by staging gigantic public bonfires of confiscated
paraphernalia and drugs in the heart of Chinatown.
The raids broke the back of the opium-smoking culture, but the addicts
moved on to morphine and heroin. The board proceeded to launch a
pre-emptive attack on "Indian hemp" or cannabis in 1913.
At the time, cannabis was virtually unheard of in California.
Nonetheless, the board warned of an influx of cannabis-using "Hindoos"
(actually Sikhs) from India, and prevailed on the Legislature to ban the
drug lest the habit spread to whites. Ironically, only after being
outlawed did marijuana become popular, eventually being used by millions
of Californians.
To a public unaccustomed to drug enforcement, the board's conduct
initially stirred consternation. The public "has been disgusted with the
sending of spies and stool-pigeons to gather evidence," the Santa Cruz
News said in an editorial. Board inspectors were accused of brutal
beatings and violence of a kind unknown in pre-prohibition days.
Inevitably, corruption also ensued. The board's chief inspector,
Frederick Sutherland, was fired amid allegations of bribery after he
married a drug-dealing widow.
In subsequent years, attitudes hardened. As black market dealers moved
in, drugs were increasingly viewed as a criminal problem. At first,
penalties were relatively mild: Sale was classified as only a
misdemeanor. Later, possession became punishable by up to six years in
prison. Originally, the board had envisioned that drug fiends would be
treated in asylums rather than sent to jail. However, funding for
asylums was repeatedly vetoed, sending addicts to prison.
As the screws tightened, the problem got worse. Federal and state laws
forced prices out of sight, pushing addicts into crime. By 1919, the Los
Angeles Times reported a "saturnalia of violent crime" caused by drug
fiends desperate to get narcotics. Stories of drug crime and violence,
rarely seen before prohibition, became a staple item in the press.
In the end, the drug laws became a giant crime-creation program.
Before 1907, the state's drug crime involved a few hundred opium den
misdemeanors. Today, the state records 400,000 drug arrests per year,
250,000 of them felonies. Drug felons -- nonexistent in 1906 -- now
account for 36,000 prisoners, 20 percent of the state's prison
population. Drug gangs plague our cities, thousands of innocent people
are victimized by prohibition-related theft and violence, and the rough
stuff has escalated into outright war in Afghanistan, Colombia and
Mexico.
Today's addiction rate is more than twice what existed during the free
market a century ago -- only about one-half percent.
After 100 years, it is hard to escape the conclusion that drug
prohibition has failed. In recent years, Californians have begun to show
second thoughts, approving initiatives to re-legalize medical cannabis
and to send drug users for treatment rather than to prison. As the state
with the longest historical experience with drug laws, it is fitting
that California should be exploring new directions out of its 100-year
war on drugs.
Dale Gieringer is California director of NORML. Contact us at
insight@sfchronicle.com.
Thursday
SAMHSA's Prevention Platform: an online resource for substance abuse prevention.
SAMHSA's Prevention Platform: an online resource for substance abuse prevention. http://preventionplatform.samhsa.gov/
SAMHSA Launches Searchable Database of Evidence-Based Practices in Prevention and Treatment of Mental Health and Substance Use Disorders
The new National Registry of Evidence-based Programs and Practices (NREPP) debuts online today, greatly expanding the Substance Abuse and Mental Health Services Administration’s efforts to help local organizations make informed decisions about evidence-based interventions for the prevention and treatment of mental health and substance use disorders.
NREPP (http://www.nrepp.samhsa.gov/) is a searchable database with up-to-date, reliable information on the scientific basis and practicality of interventions. Users, such as community organizations and state and local officials, can perform custom searches to identify specific interventions based upon desired outcomes, target populations and service settings
SAMHSA Launches Searchable Database of Evidence-Based Practices in Prevention and Treatment of Mental Health and Substance Use Disorders
The new National Registry of Evidence-based Programs and Practices (NREPP) debuts online today, greatly expanding the Substance Abuse and Mental Health Services Administration’s efforts to help local organizations make informed decisions about evidence-based interventions for the prevention and treatment of mental health and substance use disorders.
NREPP (http://www.nrepp.samhsa.gov/) is a searchable database with up-to-date, reliable information on the scientific basis and practicality of interventions. Users, such as community organizations and state and local officials, can perform custom searches to identify specific interventions based upon desired outcomes, target populations and service settings
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