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 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.
We have added several more podcasts, including two full-length lectures from an academic course on drug addiction taught at the State University of New York at Buffalo. Links for listening to the podcasts as streaming audio without downloading are embedded in the podcast titles below (i.e., click on the titles). The podcasts are listed in reverse chronological order, so you should begin on the bottom and work your way up to the latest one on the top if you wish to listen to them in sequence. You can also visit and bookmark the ASNet Podcast Directory which contains the complete listing and will usually be updated faster than our updates are posted here. You should bookmark the ASNet web page because we may discontinue use of the Podomatic hosting service at any time. We're pleased with their service, but they are another expense that we may cut to allocate our resources elsewhere. (See the bottom of the page if you would like to see us continue using their streaming audio service.)
Essential Concepts for Understanding Addiction (part-2)
Essential Concepts for Understanding Addiction (part-1)
Why Distinguishing Drug Dependence from Drug Addiction is Important
Why Distinguishing Drug Abuse from Drug Addiction is Important
Defining Addiction: What are the Necessary Attributes?
E=MC(2) and the Science of Addiction
A Primer on Addiction
We anticipate re-recording many of the 'studio' podcasts as we gain experience with this technology and consider investing in better quality equipment. Meanwhile, we wanted to get as much information out ASAP to a potentially new audience by using this popular media, so please excuse our rather amateurish quality at this time. The live lectures may be capturing the last of such lectures by the "professor" as he continues to battle health problems. Undoubtedly much of the fatigue in the mouth muscles already shows up on the recordings and hey, you never know, these may be the legacy tapes, so enjoy the live 'performances,' or not.
Finally, a donation link appears at the bottom of the ASNet podcast directory page. Our services are free, they always have been and they always will be, but of course you're free to make a donation. The podcasts incur additional expenses in increased bandwidth requirements, server storage space, and hardware upgrades (we've filled up the last few gigabytes on our hard drive; we're considering investing in better quality recording equipment). Some of the material may be of value to professionals who normally pay considerable sums for this type of training, and they are especially encouraged to make a small donation. We do not want any donations, even 'pizza money' from undergraduate or graduate students or from medical students. Save your money; buy a pizza and relax with your friends -- "these are the good old days," so enjoy them a little along the way (study and work hard too). Remember us when you have a little money to spare and consider donating then. Meanwhile, live, love, and learn.
A new category is being started for open discussion and feedback supporting our Addiction Technology Transfer Initiative (ATTI). The purpose of ATTI is to bring state-of-the-art research and 'thinking' to more people regarding drug addiction. The target audience for some presentations is academic and professional, while some presentations are intended for a general, lay audience. Others are more commentaries with a mix for everyone. You may post your comments and suggestions in this category or suggest new threads for more formal discussion (e.g., podcast format, length, or content, organization of our podcast directory). We are still receiving a lot of e-mail which we simply do not have time to reply to individually. Please use our discussion forums for correspondence that is not of a confidential nature. Your questions and our replies are likely to be of interest to many people. Over the years we have not optimized (it was tempting to use the word "wasted" here ) countless hours of work by duplicating lengthy replies to individual e-mails, and we wish to provide a mechanism to share this work and maximize its impact.
This forum is open for comments from the public and from our professional colleagues. We are eager to learn more about how we can better serve our target audiences. You may 'reply' to this commentary or initiate a new thread on a specific topic (e.g., podcasts, professional training series). There is a 24- to 48-hour delay before your comments appear because of the moderation necessary to prevent spamming.
ATTI is an important component of our mission. We have a 'game plan' on how to accomplish our goals, but your feedback can be important in directing which specific component we invest in first. Otherwise, it's 'game on' with our own strategic plan. Click here to view our our earlier statement regarding this topic when our basic research program was still operational at the Addiction Research Unit, State University of New York at Buffalo.
We have added several new podcasts this week which are listed below. We're excited about this technology and we're moving ahead, perhaps a little faster than we should according to the experts. Obviously, there is a learning curve and we hope to steadily improve our podcasts with experience. We may even go back and re-record some as we become a bit more 'professional.'
Please note that we will begin posting podcast links at the bottom of the commentaries when available. We are moving from top to bottom posting to avoid our podcast URL being displayed as the beginning of the commentary in summary tables and RSS feeds. Please scroll to the bottom if you're interested in a podcast of a specific commentary. You can also use our ASNet Podcast Directory from our website. Podcasts will be listed there by date and by several other orders of presentation when the page revisions are complete. We are duplicating the listings in different orders to help people find those of interest to our various listeners. The links below are for streaming audio which does not require download of the podcast. We are using another service for streaming podcast at the moment to keep our bandwidth demand manageable on our regular server while we gauge the interest in this channel. You can view and leave feedback as well as 'rate' our podcasts at our Podomatic home page.
ASNet Essential Concepts for Understanding Addiction (length: 1hr2min)
ASNet Why Distinguishing Drug Abuse from Drug Addiction is Important (length: 7min56sec)
ASNet Einstein and the Science of Addiction (length: 7min14sec)
Defining Addiction: What are the necessary attributes? (length: 11min48sec)
ASNet Commentary on New Opioid Prescribing Guidelines (length: 4min51sec)
ASNet Primer on Addiction (length: 15min37sec)
A new commentary is available:
Defining Addiction: What are the necessary attributes? for those who would prefer reading instead of the podcast listed above.
A new ASNet Discussion Forum category has been added to support our Addiction Technology Transfer Initiative. The new forum is provided to discuss specific issues regarding addiction technology transfer, general suggestions, and other feedback; it's intended more to address the approach, style, or other outreach ideas than the actual content of our presentations, but all topics are open. This discussion forum, our Addiction Science Network website, and our new podcast channel are all components of that program. Your comments are always welcomed. We like to know that we are reaching people and how we can improve our independent voice for Addiction Science.
Finally, we are still working on setting up our RSS feeds directly for the podcasts. In the interim, you can subscribe to the RSS feeds for our Announcements to view our list as it become revised periodically.
Obviously we are "back in the saddle again." We don't know how long we'll be on this ride before falling off our horse again, but we're rolling now. Probably by the end of November we will have to turn our attention to completing a book which has been delayed now for far too long.
The transfer of the ASNet website to another platform by the hosting service introduced a number of errors into various web pages throughout the site. A “bit” here, a “byte” there led to toggling bold print, centering lines, or dropping some HTML code into the middle of the text. Many of these problems were undetected and unreported—some just took a long time to correct because of a lack of staff. Still others are awaiting their ‘fix’ some time in the future when resources permit. (For example, numerous corrections have been made to the individual chapters of the online book on Assessing Drug Reinforcement; additional corrections and enhancements are planned.) If you have difficulty accessing a page or if you find typographical errors, problems should be reported to webmaster@AddictionScience.net for correction.
The most significant recent addition to the Addiction Science Network is the ASNet Discussion Forum. But if you’re reading this ASNet Update, you’re already well aware of the Forum. The Discussion Forum has two purposes—to educate by ‘discussing’ various terms, concepts, and other issues in drug addiction and to open some topics for general discussion and comments. Postings that specifically seek opinion are easily identified by the question or questions bold printed near the end of the posting. Commentary is always welcomed, but it is especially appreciated on these ‘open questions.’ Also, remember that RSS feeds from the ASNet Discussion Forum Announcements will take the place of the old ASNet Updates e-mail notification by the end of the year. Both the Firefox and the Sea Monkey browsers have RSS readers built into their applications as does the latest version of Microsoft’s Outlook.
AdSense is being added to most web pages. The revenue generated by participation in this program is very small even when people do click on the advertisements. The primary purpose of incorporating AdSense into the ASNet website (and into the Discussion Forum in the future) is to provide real-time data on Internet traffic for the corresponding pages. No information is collected regarding individual visitors—only information regarding the number of visitors to a page. This helps to direct limited ASNet resources to where they will have the most impact: working to improve the impact of pages with little traffic but important content, and working to further enhance the impact of already popular pages. Please note that the Addiction Science Network does not accept advertisements nor does it collect any fees from any of these ‘sponsors’ directly—the content of the AdSense displays are controlled by Google and should not be interpreted as an endorsement of any kind.
Finally, near the bottom of the AddictionScience.net home page there are acknowledgements of open source software, specifically the Sea Monkey and b2evolution programs that are used to develop this website and to provide the Discussion Forum, respectively. A link to the popular Firefox Internet browser is also included as is a link to the OpenSource.org consortium. These are unpaid, unsolicited ‘advertisements’ for these non-profit projects that provide free software for the Internet and thereby help keep the costs low at the ASNet—free is good, free is appreciated, and free is gratefully acknowledged.
Below is an example of the Google AdSense Advertisements that may appear in some postings. Clicking on these links take you to websites not affiliated with the ASNet.
A new category for commentary on the ASNet Discussion Forum is being introduced to address drug use other than addictive drug use. Specifically, this category includes the use of psychoactive substances to which the individual hasn’t developed an addiction. In some cases this will involve the use of substances to which addiction is unlikely; in other cases this will involve early-stage use of an addictive substance before an addiction has actually developed.
It is not the intent of the ASNet to encourage illicit substance use by openly discussing this topic. However, it is rather obvious that people do use illicit substances, often in a “recreational” fashion, and that such substance use will continue despite relentless government efforts for social control. It is also possible that the regulations regarding some substances that are now illicit should be relaxed and individuals should be permitted to use these substances freely or under somewhat restricted circumstances.
Before posting or commenting in this category please read the materials recommended below to learn how addiction is defined on this discussion forum, the important difference between drug abuse and addiction, and the relationship of drug dependence to addiction and to drug abuse. Misunderstanding fundamental concepts and breakdown in simple semantics contribute much to the confusion regarding the discussion of these issues.
Addiction science should withhold moral judgments regarding the use of licit or illicit psychoactive substances. Science should provide the unbiased data from which others can make rational decisions regarding their own personal use and regarding the development of formal drug-regulation policies. Within this context, the forum ‘owner’ will occasionally offer comments relevant to the science of addiction or to psychopharmacology in general, but the moral issues regarding psychoactive substance use is left for debate elsewhere (or at least confined to a single, specific ‘thread’ and not interwoven through the pages of the other topics). The topics of interest here include:
(This latter topic is related to the ASNet harm-reduction initiative and comments may be incorporated into the ASNet webpage listing “safer practices for using unsafe substances.”)
Recommended Readings 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.