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).
A central theme that I’ve been teaching in my courses on drug addiction for the past 30 years is that “drug addiction is an equally opportunity affliction.” Unfortunately, this is ‘news’ to too many of my advanced undergraduate psychology students. After just a few weeks of examining the diversity of case studies and then provided with a simple model that unifies the many ‘paths to addiction’ to a single common ‘cause,’ students become excited about the ‘recent progress’ in understanding addiction and fully expect that neuroscientists will find ‘the cure’ in short order. That is, now having recognized what really drives addiction, shouldn’t scientists be able to quickly resolve this disorder which extracts such a horrific toll on the individual, on their friends and families, and on society?
The message is what we (i.e., basic scientists) have known for years, but popular media, many clinicians, and even too many misguided drug-addiction specialists have managed to keep the pond muddied by stirring up the waters with popular discourse and dramatic portrayals played out in endless psychodrama that captivates audiences every time across time. In my primary drug addiction course alone I’ve taught nearly 3,000 400-level students during the past 26 years at the University at Buffalo. Surely there should be a multiplicative effect of my training as they go out and spread-the-word as the next generation physicians, clinical psychologists, counselors, sociologists, and even politicians. And there’s the scores of other professors just like me, some teaching this simple theme even longer. But at last, popular misconceptions like superstitions are just too damn hard to kill off. And “today’s insight” will probably remain a “new discovery” for another 25 years as this professor retires and hopefully the next one caries the torch educating and enlightening thousands more during his/her tenure as a university professor. The more things change, the more they stay the same.
The psychobiological model (Bozarth, 1990) that I teach is rather simple; it’s based largely on what is termed the “exposure model of addiction.” Basically, exposure to an addictive substance and the subsequent effect on brain reward and motivation pathways leads to addiction for many people. The varieties of personalities and subcultures that become addicted is also a product of exposure but with the added feature of psychosocial factors which govern such variables as (1) who has access to the drug, (2) who will experiment with the drug, (3) the cost and purity of the drug, (4) which drug or drugs are popular and how are they administered (e.g., “crack” cocaine is probably more addictive in some respects than is powered cocaine because of the routes they are administered despite being two forms of the same active chemical), and (5) who will find sufficient extrinsic rewards in the culture of their drug-taking behavior (e.g., peers who encourage actual drug taking and its ancillary behaviors) and thus continue their drug-taking behavior long enough for the critical neuroadaptive effects to occur which are ultimately responsible for an addiction. This is where the psychological and sociological variables exert an important influence on who is and is not likely to ultimately become an addict—during the early acquisition stage of developing an addiction. There is plenty of room for popular psychosocial and cultural variables to play a role in addiction and to present cyclic variations in “types” of people who become addicts; the role is just much different that commonly perceived. There are also high-risk groups, some genetically predisposed to experience an exceptionally strong motivating effect from their early drug-use experience and there are co-morbid disorders which may introduce a variety of secondary influences on the drug’s pharmacological effects (e.g., ADHD?, psychological depression?). Nonetheless, the “exposure model” provides a point of convergence for the sundry personalities and subcultures that find the allure of the drug irresistible. The drug is guilty; the addict makes one critical mistake—they sustain their initial use of the ‘wrong’ drug sufficiently long for the neurochemical sequel to develop which leads to addiction.
The popular media, from talk shows to Hollywood movies, will probably never get on the page and portray the real story behind addiction. They will continue to promulgate the popular myths about addiction finding better dramatic material in the cases that admittedly have an interesting story to tell about why they began their illicit substance use, while obscuring the fact that it wasn’t actually the perverted “Uncle Albert” but the drug which is the responsible agent for the addiction. The truth simply doesn’t make a good story. Mary sexually abused by her grandfather, Tom bullied as a child, Nancy stressed out by her failed sex-change surgery are much more entertaining to watch and read about, and they elicit much more empathy from viewers who can relate to various aspects of the anguish that leads to their addiction. Watching young people experiencing the intense rush produced by “crack” cocaine, bouncing from stranger to stranger on the street looking for money for the next fix to feed their cocaine craving has the home audience chanting in unison “they get what they deserve” and then quickly turning to another program. The market writes the message.
During Alan Leshner‘s tenure as director of the National Institute on Drug Abuse (1994-2001), “addiction is a brain disease” became the mantra of the Institute. Whether it’s a “disease, disorder, or syndrome” may be debatable, but it’s certainly a “brain” something unless one wishes to accept pixie dust as the mechanism behind drives and motivations, lusts and desires. The “patterns” are easy to explain—simply examine the psychological and social-cultural variables that initiate and sustain the period of early drug-use; there your personality types, sociological sub-groups and other patterns will emerge, based on who tries the drug not on why they try the drug, no requisite personality types or pixie dust required. The ‘chemicals’ in the drug interact with the ‘chemicals’ of the brain—it’s that simple.
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