The Drug Policy Digest

Wednesday, December 25, 2002
NY Times Piece On Teaching Doctors to Understand Addiction

Thanks to The Bloviator for his take on the New York Times piece "Recovering Addicts Help Educate Future Doctors" (excerpt follows). It is clear that physicians are at least as likely to get into trouble with drugs as the rest of us, and more likely to use opiate drugs (like Demerol or fentanyl) than other educated professionals. The lesson to be learned from this observation is that ready access to addictive drugs may overcome native intelligence or even years of observation about how easily casual abuse can turn into a destructive dependency. Those who suggest that legal restrictions on these drugs will result in fewer societal problems and don't acknowledge the likelihood of greater use rates and subsequent addiction should take note. Anyone desiring a well-reasoned discussion of how this might play out, should see Mark Kleiman's site and see how he examines the likely consequences of legal heroin.

But the Times piece does make one wonder how empathy for the addict can be taught without an awareness of how other physicians (or even the student herself) might wind up in the same boat as the street addict. Like most of us, the physician is capable of large measures of rationalization when the situation warrants. I recall reading of a doctor who, after speaking at some length with a heroin addict, sat at his desk pondering just how miserable a creature this person was and how wretched his existence. After a time, the doctor then reached into his desk drawer and removed a syringe and injected himself with morphine. The lack of irony in this doctor's story made it all the more telling.

Addicts are among the most difficult patients to handle as they may become dishonest and manipulative in the course of coping with their disorder. They may invent disorders in order to "scam" drugs and they seem to have virtually no tolerance for the normal discomforts of daily living -- so much so that the clinician might suspect that at least some opiate addicts are possessed of a biological disorder that makes these drugs so vital to their existence. A good deal of evidence supports this notion. Anyone who has spoken to enough addicts who say that the first time they used codeine (or morphine, Demerol, or heroin), they "knew what it was like to be normal" can't help but be impressed by this insight.

Regrettably, the underprescribing of painkillers remains a problem in medicine as doctors fear making addicts of patients in pain. This is largely an irrational fear, and can produce apparent drug-seeking behavior by patients who only desire relief from their suffering. As doctors interpret this drug-seeking as evidence of addiction, the whole process is often self-sustaining. Addiction specialists call this kind of drug-seeking by those who are undermedicated as "pseudo-addiction." It would seem clear that society might benefit if medical schools devoted more time (and other lessons) to teaching about addiction.

Recovering Addicts Help Educate Future Doctors

Jillian Polis, a second-year medical student at the Weill Medical College of Cornell University, admits that she had little if any experience with substance abuse. Raised in a suburb of Denver, she learned about drugs from popular culture.

"I thought the only people who got addicted were those who were wealthy with nothing to do or the urban poor," said Ms. Polis, 23. "I got those images from movies like `Traffic' since there was little or no addiction that I knew of growing up.' "

Jonathan Austrian, Ms. Polis's classmate at Cornell, said that he thought people used drugs simply to have a good time, and that he didn't know anyone who had been addicted.

"My only experience with drugs and alcohol was in the party setting," said Mr. Austrian, 24, who grew up in Baltimore and attended the University of Pennsylvania. "Coming from the middle-class college scene, people took drugs to enhance the party experience; they were for a good time."

Both of these students, who now admit to being naïve, got an eye-opening look at addiction this fall, during a field trip to Phoenix House, a drug treatment center in Queens. These students and several others took part in an informal but intense session in which the medical students and some residents of Phoenix House engaged in a morning of free-flowing discussion.

This monthly session, part of a class called "Medicines, Patients and Society," is designed to help students better understand addiction and develop empathy for the addicted patients they will inevitably face once they begin practicing medicine.

"Medical students often have misconceptions about people who are addicted or in recovery," said Dr. Terry Horton, medical director of the program, which began eight years ago. "Students and interns often only see addicts as the guy in the E.R. who ripped out his IV or the street person who is uncooperative. But in an urban setting, an estimated one-third of patients are going to be addicted. A medical student who becomes a physician in the community who hasn't learned that addiction is a brain disease is not going to be effective." Read the rest of the New York Times article here.

The Big Question raised here, of course, is whether addiction is a "brain disease," and, if it is, just what that means. More to come on that subject soon.

Monday, December 23, 2002
Canada's Modest Proposal: Decriminalization of Possession and Cultivation of Marijuana

Readers of this site know that Canada is considering some significant changes in its marijuana laws. The Canadian House of Commons Special Committee on the Non-Medical Use of Drugs recommended last week that the following changes in the law be implemented:

1) Possession, use, or sale of cannabis will remain illegal under Canadian law. Cannabis will continue to be listed in the "Controlled Drugs and Substance Act."

2) However, simple possession of less that 30 grams of marijuana will be deemed a "contravention" -- subject to citation and a fine.

3) Cultivation of cannabis (again, less than 30 grams) will also be included under the reform measure and offenders will be subject only to a citation and a fine. This is provided that there is no additional evidence of production of the plant for sale or if the plant contains more than 30 grams of smokeable material. (NOTE: The specifics of this provision will require some development prior to implementation. A fully mature single cannabis plant generally contains much more than 30 grams of usable material and, therefore, this provision seems to include decriminalization of cultivation of cannabis -- as long as one doesn't cultivate an entire plant.)

4) In cases where possession or cultivation of the above-mentioned amounts of cannabis are punishable only by a fine (a "contravention" offense), the offender will not have a criminal record.

Again, the details of this proposal remain undetermined, but there seems to be some momentum to this initiative. While "Drug Warriors" in the United States are understandably concerned (apoplectic might be a better description) about the prospect of Canadian decriminalization, some of Canada's own reform advocates remain skeptical. Some Canadian cannabis activists, in a textbook display of letting the perfect become the enemy of the possible, maintain that decriminalization of possession and cultivation of marijuana is "selling out." For an examination of just how this possible, and why legalization is the actual endgame of the "true believer," see AlterNet's Drug Reporter.

Sunday, December 22, 2002
Does Polling Data Reflect America's True Attitudes on Drugs and Alcohol?

In July of this year, Zogby International, in a study commissioned by the marijuana policy reform group NORML, conducted a poll of 1,109 likely voters in a national telephone survey. Participants were asked about their beliefs regarding the relative dangers associated with marijuana, alcohol, and tobacco use. They were also asked whether they were more or less likely to vote for a candidate for public office who would support not arresting adults who "smoke marijuana responsibility."

The NORML/Zogby effort has all the hallmarks of the rankest kind push-polling. For example, asking the respondent a question on drug policy preceded by the statement "Some candidates for public office favor current marijuana policies, which result in the arrest of more than 700,000 Americans each year on marijuana charges, while other candidates believe we should stop treating responsible marijuana smokers like criminals" might, just might, influence the response. Nevertheless, some interesting observations are possible.

When asked what drug is "most dangerous," the responses were: alcohol (47 percent), tobacco (28 percent), and marijuana (20 percent). Older Americans tended to cite marijuana as the most dangerous and lower income groups (less than $15K annually) were more likely to mention alcohol. Hispanic voters and, or course, voters with a professed liberal bent were most likely to say tobacco was the most dangerous.

Of course, rational drug policy considers factors other than the medical risk associated with the use of a given substance and certain drugs and medications are "grandfathered in" despite profound problems associated with their use. Aspirin would most likely not pass FDA scrutiny today and alcohol, were it introduced as a "new" recreational intoxicant at anytime in the last 50 years would most likely be restricted along the same lines as heroin or LSD. But comparisons are inevitable and the Zogby/NORML comparison is interesting despite its clear political bias.

What is most interesting, perhaps, is just how polarized the marijuana policy debate remains. 42 percent of those polled would be more likely to vote for a candidate who would de-emphasize arrest and imprisonment for marijuana offenses while 43 percent would be less likely to do so. This despite the suspicious wording of the question. Only 11 percent indicated that the candidate's stand on marijuana legalization would not influence their vote.

Next: What do Americans believe about the "incarceration versus treatment" proposals (a la California's Proposition 36) that have gained momentum in recent years?

View the data from the Zogby/NORML survey at NORML's Web Site.
For policy wonks and others interested in "push-polling" and related matters, read Josh Marshall's explanation of "Astroturf" phony grass roots organizing.

Saturday, December 21, 2002
Canada Set to Reform Marijuana Policy

Canada may decriminalize possession of small amounts of marijuana for personal use as early as spring of 2003. Canada's Justice Minister, Martin Cauchon, has indicated that he will propose legislation within the next four months that will make possession of less than 30 grams of cannabis a minor criminal offense punishable by a "small" fine. While details of the proposal have yet to be developed, it is clear that something very significant is in the works. American marijuana advocates (such as NORML) are watching this development with barely conceealed glee.

On another note, responding to a recent court decision, registered Canadian "medical" marijuana users (Canada has a national health service) may now purchase their medication over the Internet and have the material delivered to them at home.

What does all this have to do with the drug control policies in the United States? Given that decriminalization of marijuana has been the law in 12 states for some some now, it's not clear that this is such a radical policy. How (and if) the restrictions are actually enforced is going to be the biggest issue as Canada moves toward its new policies. Still, American drug war advocates are not amused. "Drug Czar" John Walters has said that the U.S. would impose trade sanctions on Canada should marijuana laws be relaxed there. Last year, similar threats were targeted at Jamaica following that nation's Parliamentary recommendation to decriminalize cannabis.

30 percent of all Canadians have used marijuana in their lifetime, and approximately 50 percent of high school students admit to having used it within the past year. In the United States, 34 percent have used marijuana during their lifetime (NHSDA 2000 Data) and 36 percent of all high school seniors admit to smoking marijuana during the past year (MTF Data 2002).

Canadian policy advocates describe the American approach as "Do Drugs, Do Time." Of course, the reality of American policy in this area is a little more complicated. According to the an October Time Magazine/CNN poll, only 34 percent of Americans want marijuana totally legalized, but 72 percent feel that simple possession for "recreational" use should be punishible by only a fine.

Thursday, December 19, 2002
Dan Burton Advocates Drug Legalization???

Another site (The Agitator) has picked up on several comments made by sometime drug warrior Dan Burton (Republican - Indiana) that seem to flirt with the idea of legalizing drugs. This is not a "slip of the tongue" but needs to be read in context to appreciate Burton's point.

Is Dan Burton's apparent conversion a "Nixon goes to China" turning point in the drug war? I doubt it, but stranger things have happened -- although I can't think of one at the moment.

Wednesday, December 18, 2002
The "Drug Czar" Reacts to "Reefer Madness" Article

On November 30th, Bill Keller published a thoughtful examination (with the unfortunate title "Reefer Madness") of the state of marijuana policy reform and criticized some of "Drug Czar" John P. Walters' rhetorical lexcesses in the War on Drugs. Now, Walters has responded to some of Keller's claims.

Walters makes several points in his response. Of those, the following require further examination:

1) The increase in the number of people needing treatment for marijuana is not, as suggested, due to "more aggressive law enforcement." Rather, Walters maintains, the increased need for treatment stems from more serious levels of use as determined by applying the American Psychiatric Association's criteria for dependence to the National Household Survey results on marijuana use rates.

In fact the numbers of adolescents (for example) who were admitted to treatment for marijuana use by way of the criminal justice system increased from about 8,800 in 1992 to some 42,300 in 1999. As a percentage of all admissions for marijuana treatment, this represents an increase in criminal justice "referrals" from 40.2 to 50.6 percent of all admissions. While the Household Survey may reflect an objective notion of the intensity and frequency of drug use (and the level of dependence or abuse as defined by the APA's DSM IV), the actual treatment admissions are more telling. (Details Here)

On a related note, whilie it is true that there has been an increase in those whose marijuana use would qualify as dependent by the APA criteria, the number remains significantly lower for marijuana (estimated at 3,473,000) than for alcohol (13, 398,000) for all age groups. Without minimizing the impact that regular use of any substance would have on younger users, the number of 12 to 17 year old Americans meeting the need for treatment for alcohol dependence (1,212,000) is also greater than for marijuana (846,000). Given that alcohol use in this age group is illegal in all states, this is a significant problem that Mr. Walters might want to acknowledge -- and all the more so when one realizes that the "Drug Czar" isn't going to advocate treating alcohol use the way marijuana use is handled by the criminal justice system. (More on Alcohol and Marijuana Dependence from the Household Survey)

2) Those sentenced for drug violations are "overwhelmingly traffickers and those with extensive criminal histories, including crimes of violence." Furthermore, "Those for whom marijuana possession is their most serious offense represent less than one-half of 1 percent of all state drug offender inmates."

This figure is, of course, little comfort to the families of those whose relatives are among the "one-half of 1 percent" who actually do go to prison for simple possession of marijuana. Furthermore, simple possession of marijuana. Of the roughly 1,500,000 drug arrests in 1999, marijuana arrests accounted for almost half (700,000) of these arrests. Only about 84,000 of these (12 percent) were for sales or trafficking in marijuana -- the rest were possession arrests.

We operate a massive prison industry for drug offenders in this country. The United States incarcerates our citizens at a rate at least 6 times greater than that of other Western democracies. In 1980, there were about 50,000 men and women in prison for drug offenses. Less than 20 years later, the number had risen to 400,000.

But Mr. Walters misses the point of those advocating reform of the marijuana laws. Marijuana is not a harmless drug and outright legalization of the drug would most likely result in higher use rates and open the door to commercialization of marijuana sales as has been seen in the Netherlands. The point of the policy reformers is (or ought to be) that, short of legalization, there are ways to make the nation's marijuana laws less punitive without sending the wrong message.

The Drug Czar's defense of the status quo is not a useful contribution to this debate.

Monday, December 16, 2002
Monitoring the Future Survey Released - Says Drug Use Among Teens Has Declined

NOTE: Fox Butterworth's piece in the New York Times is a useful addition to the Associated Press report cited below. Read Butterworth's story here.

A piece of truly good news in the drug policy arena. Drug use in general has declined among school-aged Americans. Significant drops are seen in several categories, including "Any Illicit Drug Use," "Hallucinogen Use" (especially LSD), and "Ecstasy" (MDMA). Lest we think that teenagers are substituting alcohol or other intoxicants for these substances, alcohol use is also down in most categories - including "binge" drinking (5 or more drinks in a single session) in most categories.

On a less sanguine note, some levels of use remain surprisingly high. Half of all 12th graders report having used an illicit drug. Of special concern is the non-medical use of opiate painkillers. Almost 10 percent of high school seniors (9.6 percent) admit to having abused the painkiller Vicodin. This is in line with the Household Survey's finding that nonmedical use of "pschotherapeutics" is growing in popularity, with the abuse of "pain killers" leading the list - ahead of tranquilizers, sedatives, and stimulants.

John Walters, director of the White House Office of National Drug Control Policy, said at a news conference that `This survey confirms that our drug-prevention efforts are working and that when we work together and push back, the drug problem gets smaller.'' An entirely reasonable conclusion, but an observer might be concerned about other dynamics also at work here.

What is always a concern in surveys that ask subjects to report illegal activity is the truthfulness of the responses. The MTF methodology is well respected, but it is interesting to note the symmetry between the the rise of disapproval of, say, "Ecstasy" use and the the decline in its use. Students may temper their responses based on the perceived social disapproval of their conduct -- a type of "acquiesence bias." In addition, observers have pointed out that the MTF study only questions those teenagers who remain in school. Those who drop out of school prior to reaching the final year of high school might reasonably be considered at higher risk for drug use.

The survey found 52 percent of 12th-graders noted a great risk of harm associated with Ecstasy, up 14 percentage points from 2000 figures. In addition:

--20 percent of eighth-graders said they drank alcohol in the last month, a 23 percent decline from the 26 percent who answered similarly in the 1996 survey.

--Cigarette smoking decreased in each grade, expanding on a recent trend. There has been a 50 percent decline for 8th-graders since its peak year in 1996. Eight-graders who said they had smoked in the last month fell from 21 percent in 1996 to 10.7 percent, and daily smokers fell from 10.4 percent to 5.1 percent. Smoking rates for 10th-graders fell by nearly half since 1996.

--Percentages of 8th- and 10th-graders using any illicit drug declined and were at their lowest level since 1993 and 1995, respectively.

--Marijuana use decreased among 10th graders, and in the past year, the rate of use of 14.6 percent among 8th-graders was the lowest level since 1994, and well below the recent peak of 18.3 percent in 1996. Roughly 30.3 percent of 10th graders reported marijuana use in 2002, compared with 34.8 percent in 1997.

--LSD use decreased significantly among 8th-, 10th- and 12th-graders. LSD use by 12th-graders reached the lowest point in the last 28 years.

The annual report surveys 44,000 students in 394 schools. Read the Associated Press coverage of the findings here or access the report online at ONDCP's web site.

Friday, December 13, 2002
Wall Street Journal Articles Highlight Drug Testing Industry and Methods to "Beat the System"

Both articles contain useful material along with tables describing aduleration methods and counter-measures. While the law is slowly responding by outlawing the sale of adulterants and so-called "detox" kits that purport to clean the body of traces of previously ingested drugs, the authors suggest that non-urine test may be the ultimate response -- and, I suspect, might remove some of the intrusiveness involved in urine testing.

Wall Street Journal December 11, 2002
Drug-Testing Industry Tries To Thwart Drug-Test Foilers

While a few upstarts may be determined to foil drug tests, the giant drug-testing industry is bent on foiling the foilers. But it isn't easy.

The industry has created ways to detect adulterant products in urine samples designed to hide the signs of drug use. It's starting to use tests based on hair and oral fluid, supposedly tougher to beat than urine tests. And it's taken its case to state governments -- several of which recently banned the marketing and use of drug-test adulterants.

Based on sheer size, the industry should be quashing its upstart opponents. (See related article on the "detoxification" industry.) Sixty-seven percent of major U.S. firms drug-test employees, according to a 2001 American Management Association survey, and the industry expects 2003 revenues to reach an estimated $947 million, according to Marketdata.

The drug-test foilers, meanwhile, are mostly mom-and-pop-type operations that sell their wares through Web sites and retail stories.

But the behemoth drug-testing industry is fragmented. With test manufacturers, testing labs, consultants, employers and the government all playing a part, it can be hard to put up a united front against inventive adversaries willing to try anything from simple tablets to prosthetic penises that serve as hidden sacks of somebody else's urine.

Plus, ensuring that samples aren't tampered can be an expensive proposition, one that some companies aren't willing to bear.
Finally, the law is increasingly on the industry's side. In November, North Carolina joined New Jersey, Texas, Nebraska and Pennsylvania in criminalizing drug-test foiling; neighboring South Carolina outlawed adulterants in 1999, imposing fines of up to $5,000 and three years in prison. Read More...

Related Article: "Upstarts Market Products Aimed at Foiling Drug Tests"

Thursday, December 12, 2002
"The highest percentage of domestic violence crimes were committed by people who admitted to a heavy use of alcohol and who did not test positive for drugs."

The relationship between drug or alcohol use and violent crime is complex. It is difficult to separate the "pharmacological violence" commonly associated with methamphetamine or PCP abuse from the context of the violence associated with the illicit marketplace itself. Drug sellers and buyers don't have access to the courts to mediate disputes over "turf" and product quality. Alcohol, however, has been clearly established as a causative factor in violent crime. The following article's statement that alcohol "may" be a factor is misleading.

Intoxication with alcohol has been found to be a factor in sexual assault, "acquaintance rape," and domestic violence. The correlation between alcohol use and these types of violent crimes can be established whether the perpetrator was drinking or the victim had been drinking. Complicating any analysis of the relative role of these factors is the observation that alcohol consumption by perpetrators and victims tends to co-occur -- that is, when one of them is drinking, the other one is generally drinking, as well. However, victims who had been drinking were less likely to physically or verbally resist the attacker and were more likely to suffer the most serious injuries. Several major studies have also documented the correltation between the density of retail outlets and restaurants selling alcoholic beverages and the rate of assaults with firearms and other deadly weapons.

Sacramento Bee December 9, 2002
Study Disputes Drug Link to Violence
Most arrested for violent crimes weren't under the influence, researchers say.
By Nancy Weaver Teichert -- Bee Staff Writer

Despite the perceived link between violence and illegal drug use, the highest percentage of people booked into the Sacramento County jail for violent crimes were not under the influence, a new study has found.

However, alcohol use may be a factor in violent crimes, the study indicated.

Of more than 3,000 people arrested in 2000 and 2001, those with no substance abuse were charged with the highest percentage of violent offenses.

"That flies in the face of what we expect to find," said Carole Barnes, director of the Institute for Social Research at California State University, Sacramento. "You don't need to be high to be violent."

The institute conducted the analysis in partnership with the federal Arrestee Drug Abuse Monitoring (ADAM) project, which is part of the U.S. Department of Justice.

Sacramento is one of 35 sites nationwide where federal officials are researching substance abuse by people at the time of their arrest. The study relies on urine drug tests and self-reported abuse of alcohol.

The highest percentage of domestic violence crimes were committed by people who admitted to a heavy use of alcohol and who did not test positive for drugs. -- Read more of this story.

Wednesday, December 11, 2002
"The Worlds First Digital Drug?" But, Wait... There's More!
...Yes, there's "Comatose Rose."

Yes, my friends, just in time for our holiday shopping, someone has finally introduced the "World's First Digital Drug." In reality, the not-so-aptly-dubbed "Digital Drug" looks like a palm-sized box with 2 lights that... actually flash!!! Dubbed the "Voodoo Magick Box - The World's First Digital Drug" and featuring a print ad with attractive 20-somethings having a laugh while enjoying each other, the caption reads:
"You'll feel like you're on ecstasy"

In case you missed the not-so-subtle point, there are three little purple tablets in the bottom corner of the photo. The ad continues "Experience A Non-Addictive, Non-Harmful Narcotic Substitute, Increased Relaxation, Enhanced Sexual Performance, Improved Memory and Concentration, Removed (sic) Depression and Anxiety, A 100% Legal & Safe Product that does all of this!" And all for the price low-low price of $89.95 (Shipping and Handling is extra). The Voodoo Magick Box 2 (at $119.00 +S&H) has two power settings and an extra set of electrodes - actually a set of pretty nasty looking alligator clips that attach to the ear lobes(!!).

This is what one product review called "Transcutaneous Electrical Nerve Stimulation therapy marketed toward the free love generation." TENS is of course a legitimate, if somewhat less dramatic, technique for the control of chronic pain (more about TENS here) and should not be confused with the other therapeutic technique of applying electicity for therapeutic purposes: ECT which is still used in the treatment of certain forms of depression that don't respond to other therapies (more on ECT here). It is not clear just where in this continuum one would find the Voodoo Magick Box.

The promotion of this thing goes just a wee bit over the top from here as its makers claim that it produces a "relaxed/alert" state that lasts for 12 to 72 hours. It improves sex, is useful as a study aid (since it enhances both memory and concentration), and it actually claims to ease the withdrawal symptoms associated with alcohol, street drugs, nicotine, and more. Users of the Voodoo Magick Box can expect a "significant reduction, and even total elimination" of anxiety, depression, and insomnia. And one 20 minute session can last up to 3 days! However to satisfy those pesky government regulators (buzz killers that they are), the site's FAQ page ("The Voodoo FAQ") states that "We can not and do not make any medical claims or guarantees to the efficacy or suitability of these products." Actually, they do. But check the ad and judge for yourself.

Yes, folks, that's the VoodooMagick Box (the exact spelling of the product varies within the site)! "Use the VoodooMagick Box at parties/raves, or for personal relaxation. Small enough to fit in your pocket for convenient use anywhere, any time. Experience this Amazing 100% Legal & Safe Non-Addictive, Non-Harmful Narcotic Substitute." And if that is not enough, you can see the latest ad for this wonder product in "Canada's Own Gothic/Industrial Print Magazine" Comatose Rose.

As one product review notes, "Clip it to your ears, start making out, and try not to laugh too hard." If it doesn't work, there's always the ersatz marijuana ("Stashish") sold in the back of High Times.

Tuesday, December 10, 2002
The American Medical Association reported today that alcoholic beverages may have far more damaging effects on the brains of underage drinkers than had been previously believed.

Commenting on the release of a major study that has been in the making for 20 years by the AMA and other alcohol researchers (Harmful Consequences of Alcohol Use on the Brains of Children, Adolescents, and College Students), the study's authors outline how alcohol alters the brain's development and could potentially cause irreparable damage. The possiblity that the problem of underage drinking has lead the AMA to call for a ban on alcohol advertising on network and cable television during the hours where younger viewers are most likely to be watching.

Read the Boston Globe Story on the impact of an advertising ban on television networks.

See the AMA's website for more information on alcohol and drug abuse.

The National Post reports that Canada is getting ready to decriminalize marijuana -- a development that is certain to raise eyebrows in the White House Office of Drug Control Policy.

National Post (Canada) December 10, 2002

Justice Minister prepares to decriminalize; Alliance expects legal limit of 40-plus joints
Bill Curry (National Post, with files from Southam News and The Canadian Press)

OTTAWA - The federal government will introduce legislation decriminalizing marijuana within the first four months of the new year, Martin Cauchon, the Justice Minister, suggested yesterday.

Mr. Cauchon said that should the House of Commons committee on illegal drugs recommend decriminalization in its report this Thursday, the government will respond quickly.

The committee is expected to recommend that growing pot for personal use should not be a crime. A member of the committee said the report will probably suggest a 30-gram limit for personal use.

"I mean, we'll see what will be the recommendations of the report," Mr. Cauchon told reporters. "Of course, we will have to analyze all of the recommendations and if we're talking about that question of decriminalizing marijuana, we may move ahead quickly as a government. I don't like to give you a date or a time frame, but quickly, I mean, let's say, beginning of next year. Give me the four first months of next year."

The Minister also discussed his personal views on decriminalization. "You know, I don't think I've ever really hid my position. I believe that most Canadians know where I stand," he said. "So I'm looking forward to the report and I'm looking forward to seeing the recommendations regarding decriminalization."

In July, Mr. Cauchon said the system in Canada, in which police in some provinces lay charges while others do not, might not be working as it should.

"If you look at the system that we have in place, keeping it criminal, it's not very efficient," he said then. "Depending where you are across Canada, they apply or they don't apply the legislation that we have."

Mr. Cauchon, one of the youngest members of the federal Cabinet, has also admitted he has smoked pot. ---> READ MORE...

A development in the Provigil matter. Those who have read my earlier post on the medication Provigil might be interested in reading my letter to the editor of American Medical News published in the December 2nd issue of that publication:

To the Editor: On balance, I found Susan J. Landers' article "Type A's perk up over modafinil, an anti-sleeping pill" to be an excellent discussion of a valuable medication.

However, I am concerned that the author did not mention the fact that modafinil [Provigil(R)] is a Controlled Substance (Schedule IV) with attendant abuse potential. Cephalon's own prescribing isert states that "In addition to its wakefulness-promoting effect and increased locomotor activity in animals, in humans, PROVIGIL produces psychoactive and euphoric effects, alterations in mood, perception, thinking and feelings typical of other CNS stimulants."

Without this information, the article, as published, may not adequately reflect the hazards associated with "off label" prescribing. In addition, a physician may not be sufficiently vigilant about patients seeking the medication for non-therapeutic purposes or diversion.

Paul Fishbein

American Medical News also went back to the original article and expanded the "additional information" section to reflect its status as a Controlled Substance. While Provigil may not have the abuse potential of amphetamine or methamphetamine (it is still too early to tell), the original article did not seem to consider the idea that this kind of stimulant has been widely abused in the past. It seems that with every new psychoactive medication introduced, we seem to forget the lessons of the past.

Monday, December 09, 2002
Some people should *NEVER* take hallucinogenic drugs -- people carrying automatic weapons might be the first candidates to consider abstaining:

New York Times November 29, 2002
Read the Story Online
By The Associated Press

ROSTOV-ON-DON, Russia (AP) -- A Russian soldier apparently under the influence of narcotics opened fire on fellow servicemen, killing at least eight of them and wounding three others -- the latest in a string of shooting sprees in the nation's demoralized military.

The soldier, identified as Denis Solovyov, fired his Kalashnikov assault rifle at a tent early Friday as his 11 comrades were resting while on patrol at Russia's border with Georgia in the Caucasus Mountains, the military said. Solovyov was detained immediately.

Some of the victims were killed on the spot and others died later in the hospital.

Lt. Col. Yuri Kolodkin, a duty officer with the regional Emergency Situations Ministry's branch, said a preliminary investigation indicated Solovyov was in a state of narcotic intoxication.

Other officials, who requested anonymity, said Solovyov may have eaten hallucinogenic mushrooms, which grow in the area, before the attack.

Shootings, desertions and suicides have plagued the Russian military, which is wracked by discipline, morale and funding problems.

In a similar shooting in August, two Russian border guards killed eight fellow servicemen who were asleep while on patrol in a different sector of the border with Georgia. When apprehended after a massive four-day manhunt, the guards said they killed their comrades to avenge hazing.

Vicious hazing of young conscripts by older soldiers has become an endemic problem in the Russian armed forces, resulting in a rise of killings and desertions.

In September, 54 soldiers left their unit in southern Russia and marched nearly 35 miles to the city of Volgograd to protest beatings by their officers.

On Friday, the Interfax-Military News Agency reported that a Russian border guard was missing from another area. Officials did not immediately label the soldier a deserter, saying he may have been kidnapped by Chechen rebels.

The soldier, identified as Nikolai Scherbakov, was found later Friday in a neighboring district and detained, the ITAR-Tass news agency reported.

The British Medical Journal carries a brief article describing a new magazine targeting intravenous drug users called Sister Mainline. Read the article below or on the BMJ website.

BMJ 2002;325:1368 ( 7 December )
Dutch organisation denies glamorising addiction

Roll out the clichés and puns, it's open season again on Dutch drug policy. "Pot shots" have been fired at "junkies' magazine," there has been "outrage over drug chic women's glossy," and anti-drugs campaigners are "infuriated." The British media report that a "new magazine," Sister Mainline, produced by Amsterdam's Mainline Foundation, is considered a classic example of "drug chic" publishing, a "transparent validation" of drug use, which "stinks."

Mainline, which provides health information to hard drug users, stands guilty of presenting a relatively positive self-image of women users, struggling with their addiction, but able to take practical steps to improve their health and take pride in their appearance. Even worse, say critics, Mainline has done this within the format of a "glossy" women's magazine.

Far from just saying "no," Sister Mainline offers advice on staying healthy while addicted. However, although the articles may cover fashion and beauty tips, they hardly glamorise the harsh reality of addiction.

Part-funded since 1990 by the Ministry of Health, Mainline publishes a magazine every four months with a print run of 11 000. Once a year a product is aimed specifically at women. Last year it was Mainline Lady (BMJ 323:184), which carried articles on jail, HIV, prostitution, and the difficulties of maintaining long term friendships or raising children in the drug scene. This year it will be Sister Mainline, not a magazine but a diary, shortly to be printed. It will be packaged as a present, with articles on cooking, beauty tips, and quizzes.

Mainline's Jasperine Schupp said: "We believe the `glossy' style is the best way of getting health information across to women hard drug users. Field workers asked these women what they wanted. It was a glossy `Cosmo-style' magazine, but then for drug users." Distributing Mainline Lady in Amsterdam's notorious Zeedijk red light district appeared to prove the point. After the magazine had been hyped in the Dutch press, three street prostitutes rushed up to Ms Schupp pulling on her bag, before sitting down on the pavement to read it.

"It was the dream of anyone in health information," she said. "They identified with the articles whether on motherhood or HIV testing. Their response was: `If I have this information I don't feel dirty, I feel better.'

"It is also very important to improve these women's self-esteem in order to stimulate them to take care of themselves. You don't do that by confirming a cliché junkie image, but by offering them something they can positively identify with."

Ms Schupp denied glamorising drug use. "Just read the contentswe do not promote drugs. It is all about self control, taking responsibility for your health, taking your medication on time."

After its success with the magazine, Mainline is now publishing a "glossy" diary

Mainline can do this because the Netherlands has allowed the room, within a range of policies, for harm reduction. The statistics suggest that it works. The European Monitoring Centre for Drugs and Drug Addiction puts the Netherlands around the bottom of a European Union league table of drug related deaths. It estimates that there are 2.6 "problematic hard drug users" for every 1000 people, compared with 6.7 in the United Kingdom. Meanwhile, 70% of an estimated 25 000 hard drug users are in regular contact with health services and the average age is rapidly increasing. In Amsterdam it is now 41.

Dr Hans Tieken, deputy director of Amsterdam's addiction care services, Jellinek, said: "Harm reduction does not lead to higher drug use in the general population. Targeting a specific group with a specific measure that is effective does not harm society." He explained that the target group determined whether to use harm reduction or prevention. Harm reduction is aimed at long term users, who are chronically addicted, who have been offered treatment that has not worked.

Dr Janhuib Blans, Jellinek's head of prevention work, said: "Credibility of information is the name of the game. For Mainline's target group a message like `Just Say No' would not work."

Have It Your Way?
New York Times December 8, 2002
Read the Story Online


MUNDELEIN, Ill. (AP) -- At one Illinois Burger King, authorities say, you could order a Whopper, fries and some coke. Not a soft drink but cocaine. Four people have been jailed on charges they sold cocaine from the drive-thru window at a Burger King in Mundelein.

Police had been watching the restaurant for nine months. Then on Friday night, they said, they bought about $300,000 dollars worth of cocaine from the night manager, his wife and two former employees.

Authorities said customers would either phone ahead or ask for particular employees. Then they would drive up, place their orders over the microphone and pull around the window to pick it up. The drugs were handed over in a Burger King paper bag.

Provigil (modafinil) - A Stimulant Medication With Military Applications?

Missing altogether from the following article is any specific mention of the fact that modafinil [Provigil(R)] is a Controlled Substance (Schedule IV) with abuse potential. The official (FDA) prescribing information states that "In addition to its wakefulness-promoting effect and increased locomotor activity in animals, in humans, PROVIGIL produces psychoactive and euphoric effects, alterations in mood, perception, thinking and feelings typical of other CNS stimulants." Doubtless, Provigil is an important medication if used, as approved, for the treatment of narcolepsy. Other "off label" uses may prove useful, if precautions are taken. However, if this drug becomes more widely used for depression and "sleepiness," we can expect to see the same kinds of problems that occur with more conventional stimulants such as amphetamine. To use the phrase in the article, it may be more than just "Type A's" who perk up over Provigil.

American Medical News

Type A's perk up over modafinil, an anti-sleeping pill
Doctors be ready: A medication for sleep disorders is bound to attract interest from people who are just plain sleepy.
By Susan J. Landers, AMNews staff. Nov. 11, 2002. Additional information

Washington -- A surgeon awakens groggy after a restless night, feeling less than tip-top for a tricky, 12-hour procedure. A shift worker can't cope with the circadian chaos caused by working when sleep is called for. A Wall Street lawyer puts in the usual 14-hour day and a night of socializing and must bounce back to make million-dollar decisions in the morning.

All are sleep-deprived, and all could seek modafinil, a stimulant marketed in the United States under the name Provigil by Cephalon Inc., a biopharmaceutical company in West Chester, Pa. Used in Europe for several years, it was approved in late 1998 by the Food and Drug Administration for use by patients who have narcolepsy. But could this drug also be the answer for which some of those Type A's have been looking?

So far the medication has an admirable safety record. As word of its attributes spreads, it could be tapped as a support system for fast-paced lives -- and become a topic between patients and primary care physicians.

It is already prescribed off label for people with sleep apnea and depression, and studies have shown that it is effective for multiple sclerosis patients with excessive sleepiness.

The military is interested in modafinil, and a study at Fort Rucker in Alabama found that the drug boosted the performance of sleep-deprived helicopter pilots. But another study done at Walter Reed Army Institute of Research, Silver Spring, Md., found that while modafinil works, so do six cups of coffee.

Meanwhile, modafinil has become a big seller, with its sales doubling, $72 million to $150 million, from 2000 to 2001. The company is sponsoring studies intended to broaden the drug's appeal and further boost sales.

Only a half-hour of medical school training is devoted to sleep disorders.

In late October, the company announced the results of its 12-week randomized, double-blind study of 209 patients with shift-work sleep disorder showing that modafinil significantly improved wakefulness.

The results will be used to support Cephalon's bid to expand FDA approval of the drug's use for this indication, said Frank Baldino Jr., PhD, company chair and CEO. The disorder is recognized in the International Classification of Sleep Disorders: Diagnostic and Coding Manual and is also classified as a circadian rhythm disorder by the American Psychiatric Assn.

But the inevitable question has arisen. If it works so well for people with sleep disorders, why not use it for people who are just plain sleepy?

Not so fast, specialists say. "People have to understand, this isn't better living through chemistry," said Thomas Roth, PhD, director of research at Henry Ford Medical Center in Detroit, which participated in Cephalon-sponsored studies of the drug.

While modafinil is a welcome treatment for patients with narcolepsy and certain other sleep disorders, its long-term use by healthy people is not encouraged. "I don't think people could support using something like modafinil long term in normal people based on what we know right now," said Meir Kryger, MD, director of the Sleep Disorders Center at the University of Manitoba, Canada.

"I feel very nervous about giving someone a treatment for something that is not a medical condition, but is a lifestyle thing," he added. Dr. Kryger doesn't prescribe modafinil for such patients.

But with the drug seemingly poised at the top of a slippery slope that could well lead to its use as a so-called lifestyle drug, physician prescribing patterns are key.

What primary care physicians should know about modafinil is an important issue, said Karl Doghramji, MD, director of the Sleep Disorders Center at Thomas Jefferson University Hospital in Philadelphia.

"If I correctly understand it, the company's future plans include the possibility of making an initiative to primary care physicians," he said. And the entry of primary care physicians into the sleep disorder picture would mean that many more patients would receive needed treatment, Dr. Doghramji said.

But with surveys showing that only about a half-hour of medical school training is devoted to sleep disorders, primary care physicians may face a steep learning curve, he noted.

"When do you, as a primary care physician, decide this patient has X disorder and go ahead and treat it, and when do you send the patient to a special center like a sleep disorders center?" he asked. "And if you do send a patient to a center, what do you do with the data you receive?"

Take it a case at a time

Decisions to use modafinil should be made on a patient-by-patient basis, said Neil B. Kavey, MD, director of the Sleep Disorders Center at New York Presbyterian Hospital/Columbia Presbyterian Medical Center.

While there will be some clear and proper uses for it, others will be a judgment call, said Dr. Kavey, who has prescribed the drug for off-label uses. "It's easy with the surgeon who is dealing with multiple traumas from accidents and who has to be up and up and up. You're going to give that surgeon Provigil."

Modafinil kept study subjects awake; so did six cups of coffee.

But most agree that physicians would be very careful about prescribing modafinil solely to allow healthy patients to go for long periods without sleep. "I think most clinicians are very conservative in the use of medications," Dr. Roth said.

Safety is an issue, he said. Despite its good record, modafinil is a medication, he noted, and it is intended for specific disorders. After all, "do we give people diet pills so they can eat bacon burgers? Do we give people Lipitor so they can eat yolks?"

Carl E. Hunt, MD, agreed. "There is no substitute for a good night's sleep on a regular basis," said Dr. Hunt, who directs the National Center on Sleep Disorders Research, part of the National Institutes of Health.

The sleep center is fielding many questions regarding the use of modafinil for patients who do not have narcolepsy but who are chronically sleepy. "But there are no data that suggest that would be recommended or safe," Dr. Hunt said.

Modafinil's effect on such important physiologic benefits of sleep as learning and memory, mood and behavior, appetite and resistance to disease is unknown, Dr. Hunt said.

The most common explanation for people being sleepy is they are simply not getting enough sleep, he said. In that population, no sleep medicine physician would recommend using modafinil because of the concern about side effects. "The price we pay for using it could be much more serious than any possible benefit one might get," Dr. Hunt said.


Provigil (modafinil): A central nervous system stimulant made by Cephalon Inc. and approved in 1998
Indication: Helps people with narcolepsy stay awake

Market performance: Sales of modafinil doubled from $72 million in 2000 to $150 million in 2001

New York Times December 7, 2002
Read the Story Online

National Briefing: New England

Participants in a hypodermic needle exchange program in Cambridge may not be arrested for possessing needles in Lynn or in other cities and towns that have decided not to sponsor such programs, the state's highest court held. The state law that allows such programs, which aim to reduce the transmission of blood-borne diseases by intravenous drug users, was ambiguous about whether it decriminalized the possession of needles just in those municipalities that decided to sponsor programs. The court held that allowing participants to be arrested elsewhere in the state would frustrate the aims of the law.
Adam Liptak (NYT)

Friday, December 06, 2002

RAND Study Casts Doubt on Claims That Marijuana
Acts as "Gateway" to the Use of Cocaine and Heroin

NOTE: Mark Kleiman has posted a very clear analysis of this study and it's implications here. He has also posted a link to Robert MacCoun's publication explaning that there are multiple ways that a "gateway" theory might actually operate. Mark suggests that the interested reader might enjoy Iain Murray's critique of the press coverage of this important publication.

Read the RAND Press Release
December 2, 2002

A new study by the RAND Drug Policy Research Center casts doubt on claims that marijuana acts as a "gateway" to the use of cocaine and heroin, challenging an assumption that has guided U.S. drug policies since the 1950s. However, the study does not argue that marijuana should be legalized or decriminalized.

The theory that the use of marijuana by young people causes some to graduate to harder drugs, often called the "gateway effect," has been used most recently to counter efforts to relax marijuana laws in several states. Earlier it was used to justify the imposition of tough penalties against the possession of even small amounts of marijuana.

Evidence supporting claims of marijuana's gateway effects has been found in many epidemiological studies of adolescent drug use. For instance, these studies found that marijuana users are up to 85 times more likely to use hard drugs than those who do not use marijuana, and few hard drug users do not use marijuana first.

"We've shown that the marijuana gateway effect is not the best explanation for the link between marijuana use and the use of harder drugs," said Andrew Morral, associate director of RAND's Public Safety and Justice unit and lead author of the study. "An alternative, simpler and more compelling explanation accounts for the pattern of drug use you see in this country, without resort to any gateway effects. While the gateway theory has enjoyed popular acceptance, scientists have always had their doubts. Our study shows that these doubts are justified."

The study demonstrates that associations between marijuana and hard drug use could be expected even if marijuana use has no gateway effect. Instead, the associations can result from known differences in the ages at which youths have opportunities to use marijuana and hard drugs, and known variations in individuals' willingness to try any drugs, researchers found.

The RAND study and a series of commentaries about the report are published in the December edition of the British journal Addiction, a peer-reviewed scientific publication.

"The people who are predisposed to use drugs and have the opportunity to use drugs are more likely than others to use both marijuana and harder drugs," Morral said. "Marijuana typically comes first because it is more available. Once we incorporated these facts into our mathematical model of adolescent drug use, we could explain all of the drug use associations that have been cited as evidence of marijuana's gateway effect."

"This is a very important study with broad implications for marijuana control policy," said Charles R. Schuster, a former director of the National Institute on Drug Abuse and now director of the Addiction Research Institute at Wayne State University. "I can only hope that it will be read with objectivity and evaluated on its scientific merits, not reflexively rejected because it violates most policy makers' beliefs."

RAND researchers say it is unlikely that any study will be conducted that definitively settles the marijuana gateway debate. But the authors say their study should raise questions about the legitimacy of basing national drug policy decisions on the assumption that one of the harmful effects of marijuana use is the increased risk of using more dangerous drugs.

"If our model is right, it has significant policy implications," Morral said. "For example, it suggests that policies aimed at reducing or eliminating marijuana availability are unlikely to make any dent in the hard drug problem. When enforcement resources that could have been used against heroin and cocaine are instead used against marijuana, this could have the unintended effect of worsening heroin and cocaine use."

However, the study does not conclude that marijuana should be legalized or decriminalized. "Even without the effects of a marijuana gateway, relaxing marijuana prohibitions could affect the incidence of hard drug use by diminishing the stigma of drug use generally, thereby increasing adolescents' willingness to try hard drugs," Morral said. "Moreover, marijuana itself can be a serious problem for those who become dependent on it."

Other authors of the report are Daniel McCaffery and Susan Paddock of RAND's Drug Policy Research Center, a joint program of RAND's Public Safety and Justice Program and RAND Health.

RAND researchers tested the marijuana gateway theory by creating a mathematical model simulating adolescent drug use. Rates of marijuana and hard drug use in the model matched those observed in survey data collected from representative samples of youths from across the United States. Without assuming any gateway effect, the model produced patterns of drug use and abuse remarkably similar to what is experienced across the nation, showing that a marijuana gateway effect is not needed to explain the observed behavior.

The black market in marijuana in the United States is estimated at $10 billion per year, and more than 700,000 people are arrested on marijuana charges each year. Some states have passed laws easing penalties for marijuana use. Voters in several states rejected ballot propositions in November that would have approved similar changes.

A series of commentaries by other addiction researchers that accompany the RAND study discuss some of the implications of the research and whether there is any way to create a study to unequivocally answer the marijuana gateway question.