This update lists new material on the Addiction Science Network (ASNet) website including the ASNet Discussion Forum. Beginning with “Theories of Addiction,” podcasts will be available only as downloads for playing on your mp3 player. We thank Podomatic.com for providing storage for the earlier streaming audios which remain available from their website. Click on the links below for direct feed to the new material.
New commentaries added to the ASNet Discussion Forum:
New presentations available from the ASNet Podcast Channel:
This concludes update ASNet12J10.
There are a lot of speculations floating around Washington and the country regarding likely changes in America’s drug-regulation policies during a second term for President Obama. In fact, there’s talk even outside the U.S. boarders on how highly anticipated changes in America’s traditional hard-line, zero-tolerance anti-drug rhetoric may affect international relations. Those following the depth of the international political scene will recall that the U.S. entered into what threatened to be an all-out trade war with our friends and neighbors in the north over their apparent relaxed attitude regarding marijuana regulations and their progressive harm-reduction strategies in major Canadian cities such as Toronto and Vancouver. For many Americans this was a surprise—Canadians having such independent thought on a topic long dominated by America’s political views—and a wake-up message regarding Canada’s potential status as America’s 51st state. Why, isn’t Canada just a little (albeit geographically MUCH larger) U.S.? For those that don’t get out much, they’re even on metric, eh!
Anybody notice how both candidates are ducking the issue of reformed drug laws? Drug regulation or more aptly de-regulation is not a popular topic for anybody in politics, and either party reformulating a new national policy is slated to be the looser. Of course there is a growing grass-roots movement for medicinal marijuana and even decriminalization which would condone modest “recreational” use (presumably for “adults”), but no one running for office seems to be talking about abandoning “America’s (failed?) War on Drugs.” In fact, the Replications have suggested that they will step it up. What exactly does that mean? We invaded Afghanistan and now (i.e., post our military invasion) they’re the number one producer of heroin in the world. Estimates are that up to three-quarters of the entire world’s supply of heroin is coming from that region now ostensibly ‘under U.S. control.’ How much more could the Republications “step it up” (this merits repeating: we invaded Afghanistan militarily and look at the INCREASE in drug trafficking from that region now )?
There are some new players on the block, probably too poorly organized to make a significant impact in this presidential election but growing fast enough to perhaps enter into mid-term reelections and likely players in the NEXT presidential election. I’m referring, of course, to the baby-boomers who are now dealing with the increasing aches and pains of older, sometimes well-worn bodies as they move into their 60’s and beyond. Recent changes in prescribing guidelines for opioid-based medications are placing further, often harsh restrictions on people in need of this important pain-relieving medication. There is even some evidence that some are being driven to the illicit drug market (the very market the new restrictions are designed to better control) to acquire the drugs which help them endure the unrelenting pains of living with increasing medical ills. Eventually, as the numbers grow even larger with aging baby-boomers, this group is going to push back and push back hard. But that’s probably not until another presidential election or two.
One of the first acts of President Obama’s new administration was to issue orders that relaxed enforcement of marijuana laws by federal prosecutors and provided a de facto green light to medical marijuana for states that have passed such laws. The medical marijuana and the decriminalization lobbies (not always the same ultimate goal) both resonated with optimism on the progressive outlook of our new president, one in the new model needed for a New Millennium. According to many reports this wasn’t to last: federal prosecutors began resuming their prosecution of what would be deemed “medical marijuana” cases even in states which had voted legislature recognizing medicinal marijuana—so much for the short-lived progress.
For those who have read this far eagerly awaiting some prognostications, it seems only right to make a few predictions even if on such thin air as to be about as meaningful as those made by high-priced political analysts around the country. During President Obama’s second term in office, he will probably:
There does seem an interesting Supreme Court issue here: what constitutional right does the federal government have to regulate the medical practices of individual states? This is especially perplexing in an era where medical prescriptions are filled next to displays selling copper and magnetic bracelets and various medicinal elixirs reminiscent of the patent medicine era.
So there it is, our “predictions,” or is it our “want list,” things we hope that our President will push once he’s done running for a second term? Yes, he’s likely to want an active post-presidency life and we wish him the best (see below), but he’ll be free soon to really start pushing some agendas that he has his heart in and which he (and hopefully, we too) fully support. Our “want list” is based on what we believe is demanded by the scientific evidence, and our “predictions” are based on our confidence that our President will strive to do ‘the right thing.’
Our list of predictions is sufficiently long as to increase the chances that we'll hit on at least one or two, and then we can use the epidemiologists logic of claiming cause-and-effect post hoc and brag about our influence on national drug-regulation policy. Of course we did slant our "predictions" (AKA "want list") towards a more rational drug-regulation policy and if we really wanted to ensure a few 'predicted' changes under the new administration we would cover both sides predicting a few more stringent measures too.
Anyone who has read through our predictions this far is probably wondering whether we blatantly and shamelessly exploited the name “Obama” and the keywords “presidential election” to receive more traffic on the ASNet Discussion Forum. Yes, we did! But it’s not as self-centered as it may seem. We noticed that our brief comment on Obama’s shift in marijuana policy was getting a lot of hits (surprise, surprise, it must be election time) and decided that we should exploit this opportunity to increase awareness and debate on the important issues outlined above. Do we have any more insight than the next person on President Obama’s likely changes in drug-regulation policies? Of course we don’t, but that doesn’t stop any number of would-be “expert analysts” from capitalizing on the presidential elections to promote their personal and financial interests (e.g., “look at me, I’m a big-time lobbyist,” “I was on national television”). And we sincerely hope that we effectively add another voice or two to a mandate to develop rational drug-regulation policies based on unbiased scientific evidence not begging-the-question science instructed a priori what to “discover” in the course of “scientific” research directed by some hidden agenda.
President Obama is energetic and driven by his youthful idealism. If he can survive the rigors of another 4 years without the stress-induced aging typical of young men leaving the White House as old men (check the hair colors for before and after photographs of Presidents Bush, Clinton, and yes, even Barack after his first term; there’s a definite aging effect of being president), he is most likely to remain visibly active in world politics in some important way. Perhaps like former President Jimmy Carter he will form an institute and take up a specific cause or two, supporting the rights of the disadvantaged and marginalized people around the world. It’s unlikely he’ll rest on his laurels as former President Clinton appears to have done, nor will he retire quietly to a ranch in Texas out of public life as has former President Bush. He has a long life and his youthful zeal and intellect just won’t let him stop. With this in mind, he has to be somewhat conservative in his reform of America’s drug policies and mindful of the retaliatory action of others once he’s lost the power afforded by the Presidency. Therefore, it’s unlike that we’ll see the ‘real’ Barack even after he’s elected to a second term. But then, hey, you never know; he might just take this last opportunity to try to change things from the top down and let the reformed policies ‘rock-n-roll’ into place (metaphor is to ‘going for it,’ pursuing a course of action with zeal, not to implied open season on recreational drugs in America).
For those expecting something other than a pure conjecture op ed, we recommend a recent article from the Huffington Post and offer their analysis of likely upcoming policy changes for a second-term Obama administration.
Despite our President’s popular portrayal as someone who has substantial soft-drug experience and knows how to party well, he’s a responsible parent and above that a very, very bright person. He is likely to temper his youthful experiences with the concern of a parent balanced by a careful, well-thought-out (and hopefully well advised) course of action. We can only hope that his source of “scientific” information is truly credible and not from the usual “zero-tolerance” camp of agency scientists. President Obama knows how to think and work outside the box of usual Washington politics, and we are optimistic that he will apply his talent and skills to addressing America’s drug problem with an intelligent, coherent plan of action after election to a second term in office.
Now Rock the Vote!
Most of the adverse effects associated with overdose from opioid-based medications could easily be prevented or rectified by simply making naloxone more widely available. It seems as if the medical establish is afraid that letting people know that their overdose can be quickly and effectively reversed will give patients a green light to abuse their opioid medication. Undoubtedly it will for some, but for most it should not. And there is no doubt that it would save thousands of lives!
Naloxone hydrochloride (Narcan) is a selective narcotic antagonist that rapidly and effectively reverses the effects of opioids including those associated with overdose (e.g., respiratory depression). As long as the circulatory system has not collapsed and the naloxone is able to reach the brain, it binds preferentially to opiate receptors blocking the effects of heroin, morphine, oxycodone, methadone, hydromorphone, fentanyl, opium, L-alpha-acetylmethadol, well, you get the idea, opioids.
Naloxone has no effects in people not receiving opioids. It simply blocks the effects of licit and illicit opioids regardless of who or why the drug was administered. (Yes, I know about endogenous opioid peptides [EOPs], wrote a paper or two involving those neuromodulators myself, but the effects of disrupting the EOPs are disappointing for we neuroscientists who were hoping back in the 1980s they would hold the key to everything from overeating to some forms of mental illness.) Naloxone is virtually unnoticeable in someone who has not been receiving opioids and has a very wide margin of safety for dosing in humans.
It’s shame on the medical establishment for withholding this critical information from the public. Should the medical establish and individual physicians be held responsible for these needless deaths? Is it THEIR decision to make, who will live or die based on the availability of this life-saving drug? Why aren’t patient-advocacy groups confronting the medical establishment, lobbying more strongly and unrelentingly for take-home Narcan?
Naloxone has been around for a long time. In fact, my first research using this compound was in 1975 and my first publication with it was in 1977 when I (along with Prof. Larry D. Reid) demonstrated that naloxone hydrochloride effectively and rapidly blocked morphine’s facilitatory action on electrical brain stimulation reward. I continued using naloxone in many of my experiments for the next two decades.
There are certain precautions that must be exercised when using naloxone, and proper medical training is strongly advised. (Self-instruction cards are included in some naloxone rescue kits so that more people can be reached with this life-saving treatment, although professional training is always advisable.) Two of the most important areas for concern involve the precipitation of intense withdrawal reactions and the short half-life of naloxone.
On-site resuscitation with naloxone (Narcan) is not an excuse to avoid immediate professional medical attention. For those who are concerned about getting into ‘trouble’ for their heroin overdose, consider how much trouble you or your friend will be in if you’re dead! Furthermore, naloxone is not a CSA/DEA controlled substance nor is having an illicit drug in your bloodstream an illegal act to the best of my knowledge (but then, I’m not an attorney, so I’ll “rest my case” with the first ‘argument’ – you’d be in more trouble if you’re dead).
New York State is to be commended for being among about a dozen U.S. states and several European and Asian countries where naloxone rescue kits are legally available. Unfortunately, while trying to 'fly-under-the-radar' of possible adverse public opinion, New York and other states make it difficult to find information about this important program. The public needs better education about the nature of drug addiction (and while we're at it, so do America's physicians!), and politicians need the proverbial fire lit beneath their butts to get them moving and starting to change attitudes about harm reduction. It's ironic perhaps to some people that the "rescue kits" are available mostly to illicit drug users, and the aging baby-boomers being increasingly prescribed opioid-based medications do not usually have access to this program. Well, at least it seems somewhat ironic to this baby-boomer (e.g., we are the least likely to "abuse" the "kits" in any sense of the word).
I have been advocating take-home naloxone for years as part of a harm-reduction strategy for illicit opioid users, but now there's a whole new group (and generation) that could benefit from this policy as well -- patients prescribed opioid-based medication who are sometimes overdose victims. This commentary is focused on this 'new' group, although my position on naloxone as part of a comprehensive harm-reduction strategy remains ever strong. Perhaps there should be a warning to politicians regarding this issue like the warnings that appear on the opioid medication bottles -- caution: prescription opioid-users vote!
Finally, I just have to state the obvious because I know that this is going to escape the attention of too many people. It's not just about accidental overdose in the person prescribed the opioid-based medication; it's also about the grandchildren who despite ones best efforts find and play with the pills and about the little puppies who quickly grab and devour anything accidentally spilled on the floor by fumbling old hands as if it were a tasty treat. THESE are the other potential victims, perhaps even more deserving of our concern!
This information is not intended as medical advice nor is it a substitute for proper medical training. It is strictly intended to bring this topic to the forefront of discussion and to argue for the widespread availability of take-home naloxone. Write your state and federal representatives in support of this program and acquire and learn to properly use naloxone rescue kits whenever practical (cost estimated under $10).
The reason that marijuana is unlikely to ever be approved for medicinal use in the United States is obvious -- so why isn't anybody discussing it? The first step in resolving a problem is usually acknowledging the problem, but the medical community is totally ducking this issue. Do they have a vested interest in it?
This commentary is currently only available as a podcast (length: 24 minute). Click here to listen to the discussion through streaming audio without downloading. Click here to down load the presentation directly. Or click here to visit our full podcast directory.
Usually the written commentaries precede the audio programs on this website, but this one is an exception. I've been discussing this topic for the past 12 or 15 years in my course on drug addiction in relationship to the CSA/DEA Drug Regulation Schedules. A printed version (in rough draft form) has been available for my students' use for probably the past decade. So why haven't I commented on this issue before, especially if "I know the secret"? Simple, I wanted to save SOMETHING for my book. The bigger question is, why hasn't the medical community or even NORML and other marijuana-related lobby groups been discussing it? The first answer to this two-part question is perhaps because the medical community has something to loose. I'll post NORML's reply here when I receive it. OK, you have to listen to the podcast if you want to know more. Or perhaps you already knew this too.
The only reason I'm letting the 'cat out of the bag' here is because I've decided to include the information in a podcast excerpted from one of my impromptu classroom lectures. And once it's out, it's out.
Please be advised that the presentation picks up discussing off-label prescription writing privileges currently enjoyed by American physicians. The context of the presentation is discussing the CSA/DEA Schedules for Controlled Substances in the United States. I was having a bad day, everything had gone wrong up to the presentation including running off to lecture and forgetting to copy the updated slide material I had just hastily finished for my morning lecture. (It wasn't quite [but almost ] as dumb as it sounds -- I thought I was logged onto my USB memory stick, but the file was still being saved on my hard drive.) So, an unscheduled discussion of an 'old topic' (for me) stalled off a little time to ensure that I wouldn't need the forgotten slides (other lecture material was also presented and is included in a separate podcast, part of the Addiction Science Network Addiction Training Series; the class will get the regularly scheduled material during the next lecture period).
OK, I see yet another issue and you won't have to wait for a commentary or even a podcast for this one: if there is no evidence for the medicinal use of marijuana, why did the FDA approve dronabinol (synthetic THC) for medicinal use? Replies from the FDA welcomed and will be posted here.
The FDA has argued that dronabinol can be substituted for smoked marijuana, but this isn't really true for the reasons partially described in the podcast. (And why would the FDA even argue that dronabinol substitutes for something that doesn't work according to them?) Hint: the problem with substituting orally administered dronabinol for smoked marijuana has to do primarily with how pharmacokinetics influence a drug's psychological impact (including its mood-elevating and potentially its pain-relieving properties as well). But a full explanation of how that works is in another podcast (Click here if you really want to learn about how pharmacokinetics affect a drug's psychological impact. Warning: you have to listen through a lot of material before reaching the part which addresses this topic; the presentation is a little over an hour long.)
A new podcast has been added to the AddictionScience.net website. In upcoming weeks we will be exploring this technology and assessing reader interest in producing additional podcasts. The first podcast simply presents scripted material already available from our web pages entitled "A Primer on Addiction" and "The Nature of Addiction." Click here to visit the ASNet Podcast Directory.
A new commentary is also available on drug regulation policy: New Opiate-Based Medication Prescribing Guidelines?. This is the first of what we expect to become an on-going discussion on the tightened regulations for opioid-based medications and the impact on those needing these drugs. Please see the commentary for our initial position statement and feel free to post your remarks in support or against maintaining widespread access to opioid-based medications.
This presentation is available as a podcast:
Click here to listen online without downloading.
The U.S. Food and Drug Administration (FDA) is currently revising their guidelines for prescribing opiate-based and related medications. These medicines are used daily by millions of people for the relief of moderate to severe pain. The FDA's concern is that therapeutic opiate use may lead many to addiction and therefore these medications should be more tightly controlled. The guidelines most likely would further restrict who gets opiate-based medications and under what conditions. Although we strongly support closing Internet drug companies that promote various psychoactive drugs including opiate-based medications and we further entertain the idea of a national registry to avoid duplicate prescription writing through physician shopping, we also believe that too many people now are discouraged from receiving (i.e, patients) or prescribing (i.e., physicians) medications necessary to dramatically improve the quality of life for those experiencing chronic pain.
The United States already has conservative views on the use of narcotic analgesics. Of course there is a lot of variation on opinion and on prescription-writing practices, but overall the U.S. remains rather conservative leaving millions of people under medicated for very painful conditions. Perhaps physicians should have to undergo a one-week intensive experience-pain-as-a-patient training module whereby they would be subjected to moderate but unrelenting pain for a short period of 7 days. Maybe then they would better understand the need and urgency for prescribing proper pain medication. And while we're making up the rules for the rule makers, let's add the policy makers (physician and layman alike) to our special training program. Want to see just how fast the laws and prescribing practices can change?
Patients deserve to receive their pain-relieving medication without everyone being looked upon as a potential addict. The unfounded hysteria and sensationalistic 'scientific' papers published from time-to-time need to quit exaggerating the problem for the sake of another publication and to quit marginalizing these patients who are already suffering considerably.
Very few people who receive opiate-based medication for the relief of pain become opiate addicts. Those that do are written up in reports which eventually find their way as 'scientific' articles, but the millions who don't aren't interesting and don't even make mention in such articles. The problem of addiction to prescription medication needs to be kept in perspective. Yes, many do but most don't become addicted. And of those who do progress on to addiction, the 'scientific' literature fails to note that they first entered a phase of drug abuse whereby they misused the drug by taking it outside the prescribed directions. That is, they didn't really become addicted as a consequence of their therapeutic opiate use, but rather, they abused the drug that was therapeutically made available and later became addicted. The intervening phase of drug abuse is critically important for understanding this progression. Unfortunately, it is usually ignored by those doing 'research' in this area.
(This is another instance where the distinction between drug "abuse" and drug "addiction" is critically important for conceptualizing an important issue. Better training in addiction science as part of the regular medical curriculum would be a giant step forward.) It's impossible to even discuss this topic intelligently without the requisite concepts behind the vocabulary.
Congratulations to me, "The Professor" . This commentary, drafted in September of last year (2011), was never completed or even posted in its preliminary form--another victim of "Bozarth's Law of Procrastination!" Now it's damage control time as the federal government and individual states have scared many physicians into needlessly restricting their prescriptions of opioid medications even further. Stay tuned (and subscribe to the RSS feeds) as this forum category gets shifted into high gear. Ouch that hurt .
This post was actually planned for a later date after the groundwork was laid by exploring basic topics regarding drug abuse and addiction on the ASNet Discussion Forum. However, the recent post on Salvia Divinorum (and to a lesser extent the medical marijuana post) propels this topic to the forefront a bit ahead of schedule. When discussing this topic it is essential to keep in mind the differences between drug abuse and drug addiction and their underlying causes (i.e, the biological basis of addiction vs. the psychosocial factors that often govern drug abuse). A lot of confusion arises from simple problems in semantics when discussing psychoactive drug use, the effects of such drugs, and the rights of individuals. Some of the essential concepts have been presented already on the ASNet Discussion Forum or the Addiction Science Network website (see Related Topics on the ASNet below), but others have not yet been explored adequately. Thus, this topic is a somewhat premature.
The question open for comment is: “does the individual living in a free society have the right to use psychotropic substances?” There are a number of secondary questions that arise from this topic.
The ASNet drug-regulation policy stands firmly behind the strict control of highly addictive drugs. These substances (e.g., 'hard drugs' such as cocaine and heroin) compromise the individual's ability to 'choose' whether to use the substance or not by altering the individual's motivational hierarchy in such a way as to thrust the addictive drug near the top of the person's motivational priorities (see A Primer on Addiction). On the other hand, some psychoactive substances (e.g., caffeine) clearly do not compromise the individual's self-control in a significant way and therefore can be considered part of 'life's little pleasures.' Between these two extremes lie substances that cause considerable alteration in perception, cognition, and/or affect (e.g., 'soft drugs' such as marijuana and LSD) that potentially pose a risk for the individual and for society by impairing judgment and impulse inhibition of the individual while they are experiencing the psychotropic effects of the substance (e.g., intoxication, hallucinations). This is in contradistinction to truly addictive drugs where the risk to the individual and to society is primarily when the individual is not experiencing the psychoactive effect of the drug.
Addiction science can contribute to the development of rational drug-control policy by differentiating drugs that a large proportion of individuals might be expected to ‘lose control’ of their ability to regulate their own drug-using behavior from substances that most individuals experience little difficulty in regulating their own substance use. Other issues that determine society’s acceptance of its citizens’ use of psychotropic substances involve safety (a rational consideration) and moral control (usually a non-rational consideration). Addiction science and the reporting of experimental findings should not present biased information to conform to moral control issues dictated by society or by its government agencies—it should clearly present the facts as the facts, letting individuals make rational decisions regarding personal use on the individual scale and regarding the development of rational drug-control policies on the societal scale.
Related Topics on the ASNet
A Primer on Drug Addiction
The Nature of Addiction
Distinguishing Drug Abuse from Drug Addiction
Distinguishing Drug Dependence from Drug Addiction
Biological Basis of Addiction
Hard and Soft Drugs
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An open, unmoderated discussion forum for the Addiction Science Network, promoting free and open exchange of evidence-based information and promoting scientific analysis of drug addiction and related topics.