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2/8/2016 12:00 AM

First, there was the original article, published last summer in the Journal of Addictive Behaviors — not publicized by ADAW — which said that there was no link between teen marijuana use and any mental or physical problems in adulthood. Then, last month, in a January 19 press release from the American Psychological Association, which publishes the journal, came the correction: there actually is a link between teen marijuana use and psychosis as an adult, which ADAW did write about (see ADAW, January 25). That’s quite a reversal. But that reversal is now reversed again. The APA now says it “erred” in correcting the article on January 19. 

First, there was the original article, published last summer in the Journal of Addictive Behaviors — not publicized by ADAW — which said that there was no link between teen marijuana use and any mental or physical problems in adulthood. Then, last month, in a January 19 press release from the American Psychological Association, which publishes the journal, came the correction: there actually is a link between teen marijuana use and psychosis as an adult, which ADAW did write about (see ADAW, January 25).

That’s quite a reversal. But that reversal is now reversed again. The APA now says it “erred” in correcting the article on January 19. “There were no errors in the analysis or results reported in the original study,” the APA said in the February 2 press release, adding that the authors “voluntarily conducted some additional supplemental analysis at the request of APA.”

The first correction was made after schizophrenia researcher Christine L. Miller, Ph.D., alerted the APA to the errors. The APA then issued the correction and said the original conclusion — that there is no link between teen marijuana use and problems in adulthood — was in error — that there was a link between teen marijuana use and psychosis in adulthood. A clarification was also added to the study itself on the last page. That is what we reported on in the January 25 issue.

The second correction

But on the morning of February 2, we checked the press release about the article again, and that correction had been removed. The headnote to the press release about the original study had been quietly changed from the January 19 version, and no longer stated that there was an error in the study. Citing an unnamed “controversy,” the APA said that the marijuana-psychosis link was statistically insignificant based on a tighter statistical analysis.

ADAW contacted the APA on February 2 asking why the headnote to the press release about the original study had been changed. That’s when we learned that the APA had yielded to the authors’ demand to remove any reference to any errors. And APA press officer Kim Mills told ADAW that she was sorry, that she had made a mistake.

In a press release sent to ADAW on the afternoon of February 2 — but not posted on the APA website at press time — the APA said it “erred in issuing a correction.” In that press release, the APA said even though the supplemental analyses conducted by the authors last month “indicated that teens who engaged in frequent marijuana use had a higher probability of meeting lifetime criteria for a psychotic disorder (5%) than infrequent/nonusers (2%) by their 30s, this difference did not reach statistical significance using a two-tailed test (p=.09).”

The February 2 press release states that “APA regrets its error and would like to apologize to the study authors for misrepresenting the scientific integrity of their research.”

We also contacted Dustin Pardini, Ph.D., a co-author, who told ADAW that the “APA made an egregious and irresponsible error that I have been forced to clear up over the past several weeks to protect my scientific reputation.” Pardini, who is an associate professor of criminology and criminal justice at Arizona State University, said that there “was no error in the original analysis and referring to the study in that manner constitutes a libelous statement.”

‘Everyone’s right’

So the first “oops” — that marijuana use by teens is linked to psychosis in adulthood — is followed by an “oops again.” The authors are saying that their study doesn’t show any link between teen marijuana use and adult psychosis — but not saying that it doesn’t exist.

“Everyone’s right in this case,” said Kevin A. Sabet, Ph.D., CEO of Smart Approaches to Marijuana (SAM), which encouraged the APA to run the first correction. “The researchers got upset about the word ‘error’” being connected to their work, Sabet told ADAW. But the clarification is still included with the article itself online, he said (see link at end of article). “We need to do more research on this,” he said. “We stand by what we said.”

ADAW also heard from Miller, who provided the original warnings about the study. She wrote a letter to Nancy M. Petry, Ph.D., editor of Psychology of Addictive Behaviors, concerning statistical errors in the study published last August. She said the clarification issued in the article “partially addresses” her concerns. “Whereas the corrected data as originally presented showed a one-to-one ratio of psychosis between the marijuana-use group and the low/non-use group, the uncorrected data presented in the clarification show a 2.5-to-one ratio of psychotic disorders in the marijuana use versus the low/non-use group,” she told ADAW. “It should be pointed out that it is highly unusual for correction factors to completely erase such a large difference, and thus the correction factors themselves deserve scrutiny, particularly when the 2.5-fold marijuana effect was consistent with numerous prior studies on psychosis.”

Small sample size, confounding errors

But her main concern is that the authors corrected for two factors — socioeconomic class and the health insurance status — that are more likely to be a result of psychosis, not a cause of it, and can also be influenced by marijuana use. Correcting for these factors is wrong, she said, because people with psychosis and people with marijuana use disorders have educational or economic problems, and psychosis can influence insurance status, as can marijuana use if it affects employment.

The study was also too small in size to accommodate the large number of correction factors applied by the authors, said Miller.

“Unfortunately, the APA now appears to be backing down from their characterization of the original Bechtold et al. analysis as containing a statistical error,” she said. “What is at stake for the journal is the very real possibility that if they were to impose more strict statistical standards on these authors, they would need to impose such standards on recent publications of a similar nature.”

Ultimately, Miller is concerned that the public will be misled to believe that there is no association between teen marijuana use and psychosis. “Because of the enormous public health implications of research like this, it is imperative that scholars and journals alike present data in the most accurate manner possible,” she said. “The public hears that marijuana has no relationship to psychotic disorders later in life and will change their behaviors accordingly.”

“As a long time schizophrenia researcher, now semi-retired from academia, it is my belief that the authors should publish an erratum in regards to their finding for psychosis,” Miller wrote in her letter to Petry. “The uncorrected data show an approximately 3-fold effect of marijuana and for that effect size to be completely erased by correction for covariates raises some red flags to say the least. I believe I have identified the source of their error.”

Miller’s letter detailed her critique of the statistical methods. But she also said that the “lack of statistical rigor with which the psychosis results were analyzed calls into question the entire paper.”

As a result of her letter, the APA did publish the clarification, which remains (as of press time) on the article.

For the full article, with the clarification, see http://www.apa.org/pubs/journals/releases/adb-adb0000103.pdf.

2/8/2016 12:00 AM

Kimberly A. Johnson, Ph.D., will be the new director of the Center for Substance Abuse Treatment (CSAT) at the Substance Abuse and Mental Health Services Administration (SAMHSA). Effective February 22, Johnson, currently deputy director of NIATx, will fill the CSAT post, which has not had a permanent director since H. Westley Clark, M.D., left in 2014. Johnson, formerly SSA (single state authority) of Maine, will be responsible for CSAT’s budget of more than $2 billion. SAMHSA announced the appointment late in the day on February 4.

2/1/2016 12:00 AM

It has been known for years that people formerly dependent on opioids who are coming out of prison are at increased risk for overdose. The seminal article on deaths after release from incarceration was published by Ingrid A. Binswanger and colleagues in The New England Journal of Medicine in 2007; at that time, drug overdoses were the leading cause of death after release from incarceration, but the main drug implicated was cocaine (http://www.nejm.org/doi/full/10.1056/NEJMsa064115).

It has been known for years that people formerly dependent on opioids who are coming out of prison are at increased risk for overdose. The seminal article on deaths after release from incarceration was published by Ingrid A. Binswanger and colleagues in The New England Journal of Medicine in 2007; at that time, drug overdoses -- about half from cocaine and half from opioids -- were the leading cause of death after release from incarceration (http://www.nejm.org/doi/full/10.1056/NEJMsa064115).

Today, however, opioids are the epidemic, in terms of use and overdoses. Increasingly, overdoses related to opioids upon release from incarceration have been blamed on people returning to their former doses. Likewise, many patients who go to drug-free treatment are at high risk for overdose upon release, again because it is assumed that they are returning to their former doses. But whether that is true is not clear, as the doses they used do not appear to have been studied.

“In my opinion, it’s a myth, and a dangerous one,” said Sam Snodgrass, Ph.D., a behavioral pharmacologist who works at CATAR, a buprenorphine-methadone clinic in Arkansas. Most experienced opioid users would not go back to their former doses, he said. “We aren’t that stupid,” he said. “We understand the risk of overdose, and we use what we believe is a safe dose — what we think will get us high but won’t kill us.” Unfortunately, this estimate often fails. “Too many times, that safe dose isn’t safe,” said Snodgrass.

“The point is that no one knows what dose can be fatal after a period of abstinence,” said Snodgrass. “So, if we err, then perhaps we should do it on the side of caution and tell people that what they think is a safe dose may, in fact, not be.”

In fact, even returning to a low dose of opioids after a period of abstinence could result in an overdose for a long-term opioid user, he said.

In most cases, no one knows what an overdose victim’s last dose consisted of, said Snodgrass. “But look at how many people have relapsed, used and are still around,” he said. If they had used even close to the same amount when they relapsed as they had at the end of their previous use, they would die, he said. Snodgrass knows patients who started with two hydrocodones a day and ended up using 15 to 20 roxycodones, multiple Dilaudids, or a half-gram of heroin or more in one shot. After treatment, when they relapsed, if they used even a third of what they used at the end, they would have died, he said. “As far as tolerance, they were back to being drug virgins,” he said.

Tolerance

Two top drug researchers agreed with Snodgrass about tolerance but disagreed about whether drug users are “smart” about what dose to pick up after abstinence.

“In terms of use, it is not a matter of being ‘smart,’” said Josiah D. Rich, M.D., professor of medicine and epidemiology at Brown University and director of the Center for Prisoner Health and Human Rights. “There are plenty of ‘smart’ people who develop opioid dependence—if being smart could fix the problem, they wouldn’t stay addicted.” They are “continuing the behavior despite the risk of adverse outcomes, which is the very definition of addiction.”

The two hallmarks of addiction are the development of tolerance and withdrawal, said Rich, adding that tolerance can develop fairly quickly, driving people to escalate their dose to achieve the same effect. But he agreed with the idea that tolerance can disappear quickly, which places people who have been abstinent for even a short time at risk of overdose. “Even though your mind might understand you have lost tolerance—and many people do not even know that—your body believes that you can handle it because you have done so before,” he said.

And Charles O’Brien, M.D., Ph.D., Kenneth Appel Professor at the University of Pennsylvania, said that it’s important to teach patients at discharge about tolerance. “They are smart but still can’t control drug dose,” O’Brien said, noting that naltrexone can prevent overdose. “In our naltrexone parolee study, we had seven overdoses in the control group, but zero in the naltrexone group.” He added that in the United Kingdom, parolees are released with a package of naloxone.

Reducing ‘enough’

“The majority of our clients overdose for several reasons—using too much of an opioid, the drug is stronger than usual, or mixing substances such as opioids and benzodiazepines and alcohol,” said Billy Golden of the Cincinnati Exchange, a harm-reduction organization.

Some people know to reduce the amount of opioids after a break, “but they do not reduce enough,” said Golden. “Others don’t realize that their tolerance can decrease after only a few days of being without an opioid, so they might think that they still have the same tolerance level after a week.” And others may not be able to get drugs from the same source after their break, and the drug may be stronger than what they were used to. “Here in Cincinnati, clients report that dealers often wait outside the courthouse,” he said. If someone is in withdrawal and sick, buying the drug “right then and there is going to make a lot more sense than having to go through the effort of going back to the usual source,” he said.

Hair study

The closest researchers have come to determining the dose of heroin that resulted in an overdose is in a 1998 study published in The Lancet. The researchers looked at the morphine content in the hair of heroin users who had fatal overdoses. The amounts of morphine in the hair of those who died from an overdose after a period of abstinence were significantly lower than the amounts in the hair of current users who had died. Assuming a hair growth rate of 1 centimeter per month, and assuming a positive correlation between mean heroin intake and morphine concentrations in hair, the findings showed that most of the individuals who died from a heroin overdose had abstained from heroin during the four-month period preceding the overdose. “Thus, the results of this hair analysis support a theory of high susceptibility to opioid overdose after periods of intentional or unintentional abstinence,” the study concluded. “The reasons for increased susceptibility to overdose remain unclear, but it is likely that a lower heroin tolerance after a period of abstinence, or a low tolerance owing to light or irregular heroin use, leads to a corresponding decrease in the size of a fatal dose.” (For the article, go to http://www.thelancet.com/pdfs/journals/lancet/PIIS0140673697101015.pdf.)

The bottom line is that without treatment, a period of abstinence does not treat addiction. The biggest problem for people when they get out of jail or drug-free rehab, said Golden, is “what they left behind is still waiting for them.” When the triggers are there, relapse is easy, he said, and no matter how intelligent the person is, “they can overlook the fact that their tolerance is decreased when nothing else has changed.”

Editor’s note: This is the kind of story that often has academic researchers and policymakers on one side and patient advocates on the other. To try to bridge the gap, we asked the New York State Department of Health if we could speak with their new director of drug user health, Allan Clear, formerly head of the Harm Reduction Coalition. When the Health Department press office found out what we wanted to talk about, they declined to make him available for an interview.

From the Field
6/15/2015 12:00 AM

Yet when it comes to health policy, there is only one reality: funding. While rhetoric for increasing the amount of attention paid to substance abuse has been at an all-time high, the commitment to funding by Congress has not kept up. Congressional funding for the Substance Abuse and Mental Health Services Administration’s Substance Abuse Prevention and Treatment block grant has not kept up with inflation and, as a result, would need a $450 million increase just to bring its purchasing power back to where it was in 2010. There are no signs on the horizon that this negative trend will change any time soon.

I have spent a career working on the issues of crime and substance abuse, including a time as vice president and chief operating officer of the National Crime Prevention Council. It is undeniable that substance abuse treatment for the incarcerated not only reduces recidivism, but in turn it allows its participants to at least have a chance at a productive life upon release. Based on my time working with states and communities on model state statutes and local ordinances related to drug abuse and gang violence, I can say this unequivocally.

Some members of Congress are to be praised for their efforts in the fight against substance abuse, and their recognition of the importance of treatment within the criminal justice system. In the Senate, Senators Rob Portman (R-Ohio) and Sheldon Whitehouse (D-R.I.) introduced the Comprehensive Addiction and Recovery Act (CARA), in both 2014 and 2015. Rep. Jim Sensenbrenner (R-Wis.) introduced a companion bill to CARA in the House. Senator Ed Markey (D-Mass.) introduced legislation that would expand access to medication-assisted treatment. Rep. Hal Rogers (R-Ky.), chair of the appropriations committee, remains committed to funding programs at the Department of Justice that screen for prescription drug abuse.

Yet when it comes to health policy, there is only one reality: funding. While rhetoric for increasing the amount of attention paid to substance abuse has been at an all-time high, the commitment to funding by Congress has not kept up. Congressional funding for the Substance Abuse and Mental Health Services Administration’s Substance Abuse Prevention and Treatment block grant has not kept up with inflation and, as a result, would need a $450 million increase just to bring its purchasing power back to where it was in 2010. There are no signs on the horizon that this negative trend will change any time soon.

RSAT slashed

Many members of Congress have uttered the phrase, or paraphrased, “We cannot arrest our way out of this problem.” They realize the law-and-order approach is not an effective deterrent to drug use. As a result, there has been much support in the past for the treatment of those in need who end up in the criminal justice system. One such program is the Residential Substance Abuse Treatment (RSAT) program housed by the Bureau of Justice Assistance in the Department of Justice.

According to the Bureau of Justice Assistance, 68 percent of jail inmates report substance abuse dependence prior to incarceration, with 29 percent being under the influence of drugs at the time of the offense and 16 percent committing offenses in order to obtain money for drugs. Of all jail inmates, over two-thirds were found to be dependent on or abusing alcohol or drugs. RSAT exists to help address the issue of substance abuse dependence and the direct link to public safety, crime and victimization by providing comprehensive treatment and services within the institution and in the community after a prisoner is released. RSAT funds are allocated to each state, the District of Columbia and territories based upon the respective prison population in relationship to the total prison population of all states combined.

So now, in 2015, when so many members of Congress are saying one thing, why are they doing another? Unless there is funding for programs that will benefit those in need, the words of support for treatment ring hollow. The appropriations subcommittee for Commerce, Justice, and Science (CJS) is guilty of this very hypocrisy. In their FY 2016 markup, they proposed the RSAT program be zeroed out. In layman’s terms, their recommendation was that funding for the program go from $11 million to nothing.

The CJS subcommittee slashed and burned in other places as well, and many of the programs impacted play a great role in reducing substance abuse or behavior that leads to it. Juvenile Justice programs overall are decimated, with a cut of $68 million below FY 2015 and $155.9 million below the White House request. This includes the proposed elimination of the Community-Based Violence Initiative, the National Forum on Youth Violence, the Local Delinquency Prevention Incentive grant program, the Children of Incarcerated Parents program, and a program targeting girls in the justice system.

Some politicians will recite the same tired lines. They need to prioritize. They hate to cut any programs, but in this fiscal environment, something has to go. What they are saying when they zero out a program such as RSAT is that substance abuse treatment is not a priority, especially among the incarcerated and the underserved. Such an act flies in the face of everything Congress has been telling us for the past year — that opioid abuse is the single greatest threat to our public health. If the members of the CJS subcommittee, led by Rep. John Culberson (R-Texas), truly believed this, the RSAT program would not only be fully funded, it would receive an increase. Rep. John Carter (R-Texas) is a member of the House Addiction, Treatment, and Recovery Caucus, yet he sits on the subcommittee that authored this bill. Also on the subcommittee responsible for this bill is Rep. Steven Palazzo (R-Miss.). In 2012 he joined in the celebration as a residential and workforce training center for children struggling with emotional, mental and substance abuse problems was opened in his district. Now, his committee produces legislation that will do anything but assist those with a substance abuse problem in great need of help.

It’s time for Congress to step up to the plate and fund the programs that will bring us closer to a healthier nation that fights substance abuse with every weapon in its arsenal — including appropriations.

From the Field
4/27/2015 12:00 AM

Opinion on marijuana has changed dramatically in the United States. The public increasingly perceives it as a benign substance, and there is growing interest in its potential medicinal uses. Already almost half of the states have medical marijuana laws, and congressional bills have recently been proposed that would reschedule the drug to reduce hindrances to research and facilitate marijuana’s use as medicine.

Advocates tout marijuana as a miracle drug with a wide range of potential therapeutic uses, while public health voices raise alarms about its dangers if made more widely available. The science justifying either position is often not as robust or clear as its partisans would wish. Marijuana’s impact on lung cancer remains unclear, for instance, but so does its actual range of medicinal benefits. The urgent need for more research is something all sides in the current marijuana debate can agree on. Policy changes around marijuana will need to be informed, as much as possible, by science.

There is solid evidence that the main psychoactive ingredient in marijuana, THC, is effective at controlling nausea and boosting appetite. There is also some preliminary evidence that THC or related cannabinoid compounds such as cannabidiol (CBD) may also have uses in treating autoimmune diseases, inflammation, pain, seizures and psychiatric disorders, including substance use disorders. Despite claims of marijuana’s usefulness in treating post-traumatic stress disorder, supporting data is minimal, and studies have not investigated whether symptoms may worsen after treatment is discontinued.

We do not yet know all the ways chronic treatment with marijuana or marijuana-derived compounds could affect people who are rendered vulnerable either by their illnesses or by their age. We also don’t know how medical marijuana laws will affect other aspects of public health and safety. For example, wider medical marijuana use could potentially impact driver safety, as both laboratory and epidemiological research link recent marijuana use to increased accident risk, likely reflecting marijuana’s disruptive effects on motor coordination and time perception.

Impact on teenagers

Perhaps the biggest public health concern around medical marijuana liberalization and legalization concerns the potential impact on teenagers, who could have greater access to it as a drug of abuse and who may increasingly see marijuana as a “safe, natural” medicine rather than a harmful intoxicant. Although there is still much to learn about marijuana’s impact on the developing brain, the existing science paints a picture of lasting adverse consequences when the drug is used heavily prior to the completion of brain maturation in young adulthood. In teens, marijuana appears to impair cognitive development, may lower IQ and may precipitate psychosis in individuals with a genetic vulnerability.

Most states currently don’t allow medical marijuana for children, but they too are vulnerable. Accidental ingestion of marijuana edibles by children has increased in Colorado since marijuana was decriminalized for medicinal use in 2009. Also potentially concerning is the possibility of increased prenatal exposure if women self-treat with marijuana to control nausea associated with pregnancy. Research suggests prenatal exposure could have adverse consequences for children’s future health and brain development. There is as yet no research on the potential effects of secondhand marijuana smoke on children growing up in households where parents smoke.

Even in conditions for which THC, CBD or other cannabinoid constituents of the marijuana plant prove to be medically beneficial, consumption of the marijuana plant itself or its crude extracts via smoking, vaporizing or eating is unlikely to be the most effective, reliable or safe way for patients to obtain these benefits. Laboratory research is ongoing to better understand how cannabinoids work in the brain and body and hopefully guide development of safe, reliable therapeutic compounds that have a minimum of adverse side effects.

Existing medications

Two THC-based medications, dronabinol and nabilone, are already approved by the Food and Drug Administration to treat nausea caused by chemotherapy and to boost appetite in patients with AIDS wasting syndrome. The United Kingdom, Canada and several European countries have approved a drug called nabiximols (Sativex), containing THC and CBD, as a medication for spasticity caused by multiple sclerosis (MS) and, in Canada, for MS- and cancer-related pain. Despite its success in reducing pain and spasticity, it has not received approval in the United States, and recent evidence has found impairments in cognition in users.

CBD on its own is not psychoactive and it actually mitigates the “high” produced by THC; it has been studied as a potential antipsychotic drug, and ongoing trials are testing its efficacy as an antiseizure agent. Some parents of children with severe forms of pediatric epilepsy have claimed that high-CBD (and low-THC) marijuana extracts control their children’s seizures better than existing medicines. The maker of Sativex has recently created a CBD-based drug called Epidiolex to treat children with these conditions, and is in the process of conducting initial small-scale trials. Evidence so far shows that CBD is only effective in controlling seizures in a small subset of patients.

As public approval for medical marijuana grows, we need to ensure that our policy decisions are science-based and not swayed by the enthusiastic claims made widely in the media or on the Internet. We need to support and encourage increased research on marijuana’s potential benefits and conduct intensified research on the cannabinoid system to inform the development of safe, FDA-approvable drugs. But the existing science on marijuana’s adverse effects on youth demands we also proceed with caution in making policy changes that could result in increased use of or exposure to marijuana by young people.

From the Field
10/27/2014 12:00 AM

Last week, the Harm Reduction Coalition held its conference in Baltimore. Marijuana legalization is not one of its issues, which are mainly access to clean needles and syringes, overdose prevention with naloxone, HIV and hepatitis C, and the rights of drug users. Keynote speaker Michael Botticelli, acting director of the Office of National Drug Control Policy (ONDCP), supports naloxone and medication-assisted treatment. He is a clear harm reduction advocate, but not an advocate of marijuana legalization.

But harm reduction sometimes gets confused with marijuana legalization. I had the privilege of speaking to the “Politics” class at American University in nearby Washington, D.C. on October 20, a few days before the conference was to begin. I was invited to discuss the movement toward drug legalization. I also covered some “harm reduction” assertions as well.

Unfortunately, because the legalization movement is sweeping across America, my counterpoints were very well-received — I say “unfortunately” because we are being overcome by the tidal wave of the movement. Here is some of what I said to Assistant Professor Rick Semiatin’s “Washington Semester” class of juniors and seniors from 200 colleges and universities across the United States.

I’m a “liberal” on most things, but on the drug issue, I know the harm that is done by car crashes, DUIs, date rape and the impact of flooding already overcrowded emergency rooms — and that includes from marijuana, which most “legalizers” claim they want to separate from “harder” drugs. I was the one who wrote then-Congressman Ed Koch’s testimony on his bill in the 1970s to legalize marijuana, and sat with him at the table as he told Congress that drugs are personal and harmless, and that we should stop crowding our prisons. But both Ed and I learned and changed our positions, he as mayor of New York City and me as I learned more and more as spokesman for the House Narcotics Committee and then the White House ONDCP.

I told the students that the election is being overwhelmed by the issue because my own party, the Democrats, don’t want to touch it. They are afraid their candidates will lose a big chunk of the youth and liberal base who support legalization/decriminalization in the legislatures and state referenda. Like laetrile in the 1970s (which was legalized in more than 20 states and was supposed to cure cancer but turned out to be useless apricot pits that simply deferred real and needed treatment), “medical” marijuana is backed up only anecdotally and never is compared to an “n” of other treatment modalities that would be prescribed by doctors. There is truth to former drug czar Barry McCaffrey’s joke that a shot of gin also takes away your pain. Having said that, no one wants to deny a truly sick or dying patient who wants to get high the opportunity to feel better, even if it’s a placebo effect. It’s not the truly “medical” cases anyone wants to stop; it’s what law enforcement tells us are the 90-percent-plus (and as many as 99 percent) nonsick people who also come in to the clinics feigning illness with a makeshift letter just to get drugs.

Harms of marijuana

The evidence on harm in the legalizing states is rolling in. You have to scrounge for the reports, but they say, “youth marijuana use increased by nearly 11 percent since medical marijuana became legal in 2009,” “traffic fatalities involving drivers testing positive for marijuana have increased by 100 percent between 2007 and 2012” and “toxicology reports with positive marijuana results for driving under the influence have increased 16 percent from 2011 to 2013.” In addition, Colorado Public Radio reported, “Denver Emergency Room Doctor Seeing More Patients for Marijuana Edibles.” The United Nations reported, “Marijuana-related Health Problems on Rise in US,” with a 12 percent rise last year in marijuana usage by teens.

But for the most part, the legalization referenda are speeding ahead. The most-cited ones, in Oregon and D.C., show legalization 11 and 20 points up, respectively, with just days before the election, and the legalization advocates say they are counting on “young voter turnout.” Since Democrats count on that demographic as well, you can understand the silence.

Even though Maryland Governor Martin O’Malley told me personally two weeks ago that “I’m concerned about legalization” because of car crashes, emergency room upticks, the horrible message to kids (how legalization disarms parents from the moral high ground on the message), and the like, politicians in the state are silent on the issue.

Of course, the legalizers say the drug war is a “failure.” But the students I addressed did open their eyes when I said that because of the efforts of parents, teachers, coaches and religious and business leaders, and a strong foreign policy (Plan Colombia) and domestic enforcement efforts, drug use has declined almost 50 percent in the last three decades, and cocaine use — the disproportionate driver of crime — is down 70 percent. If any other social problem, such as literacy, hunger or poverty, or health problem, such as cancer, diabetes and heart attacks, improved 50–70 percent, would we call it a failure?

To these quite smart college juniors and seniors, I pointed out that medically assisted treatment — including methadone, buprenorphine and Vivitrol — is in fact harm reduction. It’s valid because people can function, work and pay taxes. But if we’re talking about heroin, cocaine and methamphetamine to addicts, that’s pure nonsense that destroys their lives. If we are talking about marijuana, I still oppose it because it jams hospital emergency rooms with car crashes and treatment centers with patients. Legalization or decriminalization would simply increase availability and use. When I debate the Ethan Nadelmanns of the world on radio or Bill Maher or Crossfire, they invariably say, “That’s true but…” I cut in and say, “You can’t say ‘but’ to more availability and use — that’s the point. Aside from that, Mrs. Lincoln, how was the play?”

I do concede we need to stop prison overcrowding but point out that’s why Attorney General Janet Reno and ONDCP Director McCaffrey supported creating drug courts, for treatment instead of prison for nonviolent drug offenders. There were eight drug courts when we started in 1996. Drug courts rose to 1,000 under Clinton-Reno-McCaffrey, and now are near 3,000.

Science, not politics, should guide U.S. drug policy.

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  • Meet the Editor

    Alison Knopf
    Editor

    Alison Knopf is a professional journalist who began covering the addiction field in 1984 as founding editor of Substance Abuse Report. She has been the editor of Alcoholism & Drug Abuse Weekly since 2005.
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