Why marijuana is unlikely to ever be approved for medicinal use in the United States

Link: http://AddictionScience.net

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' ;D 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 :oops: ] 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 :lalala: 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.)

Yes, I know, I could have written the entire commentary in probably fewer words than it took to set up the background for the podcast. But it's more fun keeping you in suspense and I don't have to worry so much about grammar and parallel sentence structure. (Really, I 'worry' about those things; doesn't it show? ;))

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Addiction is an Equal Opportunity Affliction

09/26/12 | by the professor [mail] | Categories: General, Harm-Reduction Strategies, Addiction Technology Transfer Initiative

Link: http://AddictionScience.net

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.

Suggested Reading:

Drug Addiction as a Psychobiological Process
Pleasure systems in the brain

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ASNet Update12L26

09/25/12 | by the professor [mail] | Categories: General, Announcements

Link: http://AddictionScience.net

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.:)

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Addiction Technology Transfer -- New Discussion Forum on the ASNet

09/23/12 | by the professor [mail] | Categories: General, Announcements

Link: http://AddictionScience.net

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.

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ASNet Update12L21

09/21/12 | by the professor [mail] | Categories: General, Announcements, Nomenclature, Addiction Technology Transfer Initiative

Link: http://AddictionScience.net

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.

New Podcasts
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)

Earlier Podcasts
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. :oops:

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Defining Addiction: What are the necessary attributes?

09/15/12 | by the professor [mail] | Categories: General, Nomenclature

Link: http://AddictionScience.net

We have chosen to define “addiction” as a behavioral syndrome where drug use and procurement seem to dominate the individual’s motivation and where the normal constraints on behavior are largely ineffective. There are other important attributes of addiction that are usually included in various definitions of this term. The question of interest is whether other attributes are necessary components of a formal definition or whether they add needlessly to the number of terms used to define what we mean by “addiction.” Succinct definitions not only ‘save words,’ but they keep the focus on the primary variable(s) of interest and help to prevent confusing effects with causes in our definitions. The definition adopted here is less than 25 words, and there are definite advantages to keeping definitions sufficiently short so as to simply memorization and to facilitate accurate conveyance amongst those discussing the same phenomenon. One of the biggest challenges to any discourse, whether it be lay, academic or professional, involves semantics or making sure that all parties are actually discussing the same thing. Succinct, consensually accepted definitions facilitate conversations at all levels.

The “Pizza and beer” syllogism is perhaps the most famous example illustrating how a statement that seems logically correct leads to an erroneous conclusion.

  • Pizza and beer are better than nothing.
  • Nothing is better than going to heaven.
  • Therefore, pizza and beer are better than going to heaven!

The syntax is logically correct, but there is a breakdown in semantics involving the meaning of the word “nothing” that invalidates the apparent conclusion. In the first context “nothing” refers to “the absence of anything,” while in the second context it refers to “no-thing.” It is critically important to avoid these types of semantic breakdowns in discussions of addiction, and thus the need for a concise definition that identifies the defining attribute(s) of an addiction while relegating the others characteristics often included to descriptive text.

Addiction is often defined as “a chronically relapsing disorder” or “disease” (whether addiction is indeed a “disorder” or a “disease” is a point of considerable debate in itself; see Drug Addiction as a "Disease"). The phrase "chronically relapsing" certainly describes an important characteristic of an addiction, but is it necessary in a concise definition? The intense motivational strength of an addiction not only predicts the high relapse rates, but it also predicts other attributes of addiction such as motivational toxicity which describes the drug’s impact on normal motivated behaviors such as eating and sexuality. The fact that a single attribute (i.e., motivational strength) can predict from simple logical deduction several other characteristics that are commonly seen in addiction makes this single attribute more valuable as the defining characteristic than is compiling an unnecessarily longer list of characteristics for inclusion in the formal definition of addiction. These other commonly observed features are perhaps best considered simply “characteristics” of an addiction because they can all be derived from the single defining attribute (i.e., high motivation for drug administration). This same logic also applies to adding “motivational toxicity” to formal definitions of addiction. While it may appear to be a defining characteristic, the motivational toxicity inherent in an addiction can also be predicted by simply understanding that addictive drugs produce an intense motivational state and thus even if they lacked their ability to blunt the rewarding impact of natural rewards they would still seemingly overtake the normal motivations in the individual’s life. The same might be said for the second characteristic included in our definition, specifically, that “the normal constraints on behavior are largely ineffective,” but this phrase not only underscores the intense motivation to obtain the addictive drug but also reminds the reader that motivational strength is reflected not only in how hard one will work for the goal object but also by the willingness to overcome aversive conditions which might normally inhibit goal-directed behavior.

Other considerations for inclusion in a comprehensive definition of addiction include the addict’s perceived sense of a “loss of control.” Again, this variable might be deduced simply by considering that the normal choice perceived when several, closely competing goals which vie for the individual’s ‘attention’ and behavior are obviated by a single, overwhelmingly strong motivator—the addictive drug. In other words, the cognitions associated with classic approach-approach and approach-avoidance conflicts might give rise to a sense of ‘choice,’ and these conflicts are less prominent in cases where the motivation to ‘approach’ the goal object (in this case, use the drug) is so strong as to dominate unquestionably the other motivations. In such cases the perception of choice might be absent and the individual may feel that they no longer have control over their own behavior, but rather, that they are being driven by some external force. In a sense they are correct—the stimulus properties of the drug and other cues in conjunction with the (largely unconscious) anticipation of reward engage the individual’s behavior in a manner consistent with the notion of “enslavement” to the external agent (i.e., functionally the drug is serving as the ‘master’ and the addict as the 'slave'). As discussed elsewhere, this apparent “enslavement” is consistent with the etymology of the term “addiction” and adds credence to the use of the term in this fashion as opposed to the popular misconception of “addiction” as physical dependence upon a substance.

The last consideration that might be addressed by our definition of addiction is whether we consider it a disease or a disorder. The definition used here avoids this debate by simply defining “addiction” as a “behavioral syndrome.” Whether it is truly best considered a disease or a disorder is moot for our definition which emphasizes the behavior of the individual as being the primary descriptive variable and hence is consistent with the term’s etymology of "addiction" as "enslavement." As discussed elsewhere, the disease-disorder debate resolves down to one largely of who ‘owns’ the territory—the medical establishment or psychologists, counselors, and social workers (see Drug Addiction as a "Disease"). There are of course other important considerations for whether a pathology is considered a disease or disorder, such as locus of control—biological or more “psychological”—along with the ensuing implications of how to best approach treatment and the degree of individual responsibility for their own ‘problem’ (e.g., the use of the term “disease” implies that the individual has relatively little control over the course of the pathology and that some external treatment is necessary to remediate the problem). There would appear to be no advantages to including the term “disorder” in a formal definition of addiction, but additional characteristics conveyed by the use of the term “disease” merit further consideration for future revisions to our ‘working’ definition. On the other hand, the use of the term disorder would imply that addiction is not a disease, while the description as “a behavioral syndrome” avoids pronouncement on this hotly debated topic.

It is always tempting when formulating definitions to be all encompassing or at least to describe enough of the phenomenon under discussion to vividly illustrate its many facets. Indeed, the more one knows the more eagerly one tries to share their knowledge with anyone and everyone who will listen. Understanding the many aspects of addiction, something shared by more than a few researchers and clinicians, seemingly implores one to offer mini-lectures or tutorials at every opportunity. And when it comes to formal definitions, the desire to share all often gets the best of even academic scholars who should understand well the need for concise definitions devoid of superfluous adjectives. Nonetheless, multifaceted phenomena like addiction are often described from the perspective of individual disciplines studying only one or a few of its many features without trying to identify a common underlying variable responsible for the various attributes.

In this way most definitions focus too much on the vicissitudes of addiction which distract from the core phenomenon responsible for these other, secondary characteristics. Indeed, this often overshadows the primary characteristic of an addiction. In other words, the motivational characteristic of an addiction (which is used here as the basis for its definition) produces the other features such as “chronically relapsing disorder,” the addict’s “perceived loss of control,” and even the “motivational toxicity” inherent in an addiction. Inclusion of these other, secondary characteristics tends to obscure the primary characteristic of the addiction and in some respects seemingly confuses its effects with its cause (i.e., the intense motivational strength can be viewed as the cause and these other features as effects of the addiction!) This is an example of why good science strives to simplify things, to render them in their simplest, not most complex, terms; good definitions like good theories retain a vision of “the forest for the trees,” hence not letting the details obscure the bigger picture. In case anyone is still wondering whether a useful definition of addiction can be resolved down to just 25 words or less the answer is yes, indeed it can, and we are better off ‘keeping it simple stupid’ to ensure the semantic integrity of our discussion of this seemingly complex, multifaceted phenomenon.

So what do we have nearly 1400 words later when we’ve finished with this relatively brief examination of the terms frequently used to define addiction? We’re right back where we started: “addiction” can be defined as a behavioral syndrome where drug use and procurement seem to dominate the individual’s behavior and where the normal constraints on behavior are largely ineffective. The difference between the closing and beginning positions of this discourse lies in the certainly with which we succinctly define addiction—acknowledging the phenomenology of these other important attributes, but rendering their incorporation into a formal definition of addiction (albeit a ‘working’ one) unnecessary.

The podcast of this presentation can be downloaded from our ASNet Podcast Directory.

Click here to listen to the podcast without downloading (length: 11min48sec). Click on the ASNet podcast logo (Anpu) to pause the imbedded player.

Other related commentaries:
A Primer on Drug Addiction
Distinguishing Drug Abuse from Drug Addiction
Drug Addiction as a "Disease"

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ASNet Update 12L12

09/12/12 | by the professor [mail] | Categories: General, Announcements, Drug-Regulation Policy

Link: http://AddictionScience.net

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.

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