Tag Archives: RAND Corporation

Rand Corporation study: Study questions link between medical marijuana and fewer opioid deaths

11 Feb

Often children who evidence signs of a substance abuse problem come from homes where there is a substance abuse problem. That problem may be generational. eMedicineHealth lists some of the causes of substance abuse:

Substance Abuse Causes
Use and abuse of substances such as cigarettes, alcohol, and illegal drugs may begin in childhood or the teen years. Certain risk factors may increase someone’s likelihood to abuse substances.
Factors within a family that influence a child’s early development have been shown to be related to increased risk of drug abuse.
o Chaotic home environment
o Ineffective parenting
o Lack of nurturing and parental attachment
Factors related to a child’s socialization outside the family may also increase risk of drug abuse.
o Inappropriately aggressive or shy behavior in the classroom
o Poor social coping skills
o Poor school performance
o Association with a deviant peer group
o Perception of approval of drug use behavior
http://www.emedicinehealth.com/substance_abuse/article_em.htm

Substance abuse is often a manifestation of other problems that child has either at home or poor social relations including low self-esteem. Dr. Alan Leshner summarizes the reasons children use drugs in why do Sally and Johnny use drugs? http://archives.drugabuse.gov/Published_Articles/Sally.html

Science Daily reported in: Depression among young teens linked to cannabis use at 18:

A study looking at the cumulative effects of depression in youth, found that young people with chronic or severe forms of depression were at elevated risk for developing a problem with cannabis in later adolescence.
The study led by UW Medicine researchers interviewed 521 students recruited from four Seattle public middle schools. Researchers used data from annual assessments when students were ages 12-15 and then again when they were 18. The results were published in the journal Addiction.
“The findings suggest that if we can prevent or reduce chronic depression during early adolescence, we may reduce the prevalence of cannabis use disorder,” said lead author Isaac Rhew, research assistant professor of psychiatry and behavioral sciences at the University of Washington School of Medicine.
What researchers called “a 1 standard deviation increase” in cumulative depression during early adolescence was associated with a 50 percent higher likelihood of cannabis-use disorder.
According to researchers, during the past decade cannabis has surpassed tobacco with respect to prevalence of use among adolescents. Cannabis and alcohol are the two most commonly used substances among youth in the United States. They pointed to one national study showing increases in prevalence of cannabis use disorder and alcohol use disorder in the United States, especially among young adults.
Longitudinal studies looking at the link between depression and later use of alcohol and cannabis, however, have been mixed. Some show a link. Others don’t. But most studies have assessed adolescent depression at a single point in time — not cumulatively, said the researchers. Further, there have been differences in how substance use has been measured ranging from the initiation of any use to heavier problematic forms of use.
The study oversampled for students with depressive and/or conduct problems. The researchers were surprised to see that the prevalence of cannabis and alcohol use disorder in this study was notably higher than national estimates with 21 percent meeting criteria for cannabis use disorder and 20 percent meeting criteria for alcohol use disorder at age 18.

What effect the easing of marijuana laws in Washington state had on the youth is unclear. Researchers said it would be informative to conduct a similar study in a state with more strict marijuana laws to understand whether the relationship between depression and cannabis misuse would still hold in areas where marijuana may be less accessible…. https://www.sciencedaily.com/releases/2017/07/170717151031.htm

Citation:

Depression among young teens linked to cannabis use at 18
Seattle-focused study suggests earlier intervention with depressed youths could reduce rate of cannabis-use disorder
Date: July 17, 2017
Source: University of Washington Health Sciences/UW Medicine
Summary:
Young people with chronic or severe forms of depression were at elevated risk for developing a problem with cannabis in later adolescence, found a study looking at the cumulative effects of depression in youth.

Journal Reference:
1. Isaac C. Rhew, Charles B. Fleming, Ann Vander Stoep, Semret Nicodimos, Cheng Zheng, Elizabeth McCauley. Examination of cumulative effects of early adolescent depression on cannabis and alcohol use disorder in late adolescence in a community-based cohort. Addiction, 2017; DOI: 10.1111/add.13907

Science Daily reported in Study questions link between medical marijuana and fewer opioid deaths:

The association between medical marijuana and lower levels of opioid overdose deaths — identified previously in several studies — is more complex than previously described and appears to be changing as both medical marijuana laws and the opioid crisis evolve, according to a new RAND Corporation study.
The report — the most-detailed examination of medical marijuana and opioid deaths conducted to date — found that legalizing medical marijuana was associated with lower levels of opioid deaths only in states that had provisions for dispensaries that made medical marijuana easily available to patients. Opioid death rates were not lower in states that just provided legal protections to patients and caregivers, allowing them to grow their own marijuana.
In addition, the association between medical marijuana dispensaries and fewer opioid deaths appears to have declined sharply after 2010, when states began to tighten requirements on sales by dispensaries.
“Our findings are consistent with previous studies showing an association between the legalization of medical marijuana and lower deaths from overdoses of opioids,” said Rosalie Liccardo Pacula, co-author of the study and co-director of the RAND Drug Policy Research Center.
“However, our findings show that the mechanism for this was loosely regulated medical marijuana dispensaries, and that the association between these laws and opioid mortality has declined over time as state laws have more tightly regulated medical dispensaries and the opioid crisis shifted from prescription opioids to heroin and fentanyl,” Pacula said. “This is a sign that medical marijuana, by itself, will not be the solution to the nation’s opioid crisis today….”
When the researchers narrowly focused on the time period from 1999 to 2010 and replicated a model used by other researchers, they obtained results similar to those previously published, showing an approximately 20 percent decline in opioid overdose deaths associated with the passage of any state medical marijuana law. However, these general findings were driven by states that had laws allowing for loosely regulated marijuana dispensary systems.
When researchers extended their analysis through 2013, they found that the association between having any medical marijuana law and lower rates of opioid deaths completely disappeared. Moreover, the association between states with medical marijuana dispensaries and opioid mortality fell substantially as well.
The researchers provide two explanations for the decline in the association between medical marijuana dispensaries and opioid harm. First, states that more recently adopted laws with medical marijuana dispensaries more tightly regulated them, in response to a U.S. Justice Department memo saying it would not challenge state-level medical marijuana laws so long as dispensary sales were in full compliance with state regulations. Second, beginning in 2010, the primary driver of the opioid crisis and related deaths became illicit opioids, mainly heroin and then fentanyl, not prescription opioids…. https://www.sciencedaily.com/releases/2018/02/180207090111.htm

Citation:

Study questions link between medical marijuana and fewer opioid deaths
Association appears to be changing as medical marijuana laws and opioid epidemic change
Date: February 7, 2018
Source: RAND Corporation
Summary:
Several studies have shown an association between legalizing medical marijuana and lower death rates from opioids. A new study finds that link is more complex than previously described and appears to be changing as both medical marijuana laws and the opioid crisis evolve.
Journal Reference:
1. David Powell, Rosalie Liccardo Pacula, Mireille Jacobson. Do medical marijuana laws reduce addictions and deaths related to pain killers? Journal of Health Economics, 2018; 58: 29 DOI: 10.1016/j.jhealeco.2017.12.007

Here is the press release from RAND:

Do Medical Marijuana Laws Reduce Addictions and Deaths Related to Pain Killers?
Published in: Journal of Health Economics Volume 58 (March 2018), Pages 29-42. doi: 10.1016/j.jhealeco.2017.12.007
Posted on RAND.org on February 08, 2018
by David Powell, Rosalie Liccardo Pacula, Mireille Jacobson
• Related Topics:
• Drug Markets and Supply,
• Marijuana,
• Substance Use Harm Reduction
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Read More
Access further information on this document at Journal of Health Economics Volume 58 (March 2018)
This article was published outside of RAND. The full text of the article can be found at the link above.
Recent work finds that medical marijuana laws reduce the daily doses filled for opioid analgesics among Medicare Part-D and Medicaid enrollees, as well as population-wide opioid overdose deaths. We replicate the result for opioid overdose deaths and explore the potential mechanism. The key feature of a medical marijuana law that facilitates a reduction in overdose death rates is a relatively liberal allowance for dispensaries. As states have become more stringent in their regulation of dispensaries, the protective value generally has fallen. These findings suggest that broader access to medical marijuana facilitates substitution of marijuana for powerful and addictive opioids.
Access further information on this document at Journal of Health Economics Volume 58 (March 2018)
Link Between Medical Marijuana and Fewer Opioid Deaths Is More Complex Than Previously Reported
FOR RELEASE
Tuesday
February 6, 2018
The association between medical marijuana and lower levels of opioid overdose deaths—identified previously in several studies—is more complex than previously described and appears to be changing as both medical marijuana laws and the opioid crisis evolve, according to a new RAND Corporation study.
The report—the most-detailed examination of medical marijuana and opioid deaths conducted to date—found that legalizing medical marijuana was associated with lower levels of opioid deaths only in states that had provisions for dispensaries that made medical marijuana easily available to patients. Opioid death rates were not lower in states that just provided legal protections to patients and caregivers, allowing them to grow their own marijuana.
In addition, the association between medical marijuana dispensaries and fewer opioid deaths appears to have declined sharply after 2010, when states began to tighten requirements on sales by dispensaries.
“Our findings are consistent with previous studies showing an association between the legalization of medical marijuana and lower deaths from overdoses of opioids,” said Rosalie Liccardo Pacula, co-author of the study and co-director of the RAND Drug Policy Research Center.
“However, our findings show that the mechanism for this was loosely regulated medical marijuana dispensaries, and that the association between these laws and opioid mortality has declined over time as state laws have more tightly regulated medical dispensaries and the opioid crisis shifted from prescription opioids to heroin and fentanyl,” Pacula said. “This is a sign that medical marijuana, by itself, will not be the solution to the nation’s opioid crisis today.”
The study was published online by the Journal of Health Economics.
Researchers from RAND and the University of California, Irvine, analyzed information about treatment admissions for addiction to pain medications from 1999 to 2012 and state-level overdose deaths from opioids from 1999 to 2013. They also identified state laws legalizing medical marijuana, examining provisions such as whether the regulations made marijuana easily accessible to patients by allowing dispensaries.
When the researchers narrowly focused on the time period from 1999 to 2010 and replicated a model used by other researchers, they obtained results similar to those previously published, showing an approximately 20 percent decline in opioid overdose deaths associated with the passage of any state medical marijuana law. However, these general findings were driven by states that had laws allowing for loosely regulated marijuana dispensary systems.
When researchers extended their analysis through 2013, they found that the association between having any medical marijuana law and lower rates of opioid deaths completely disappeared. Moreover, the association between states with medical marijuana dispensaries and opioid mortality fell substantially as well.
The researchers provide two explanations for the decline in the association between medical marijuana dispensaries and opioid harm. First, states that more recently adopted laws with medical marijuana dispensaries more tightly regulated them, in response to a U.S. Justice Department memo saying it would not challenge state-level medical marijuana laws so long as dispensary sales were in full compliance with state regulations. Second, beginning in 2010, the primary driver of the opioid crisis and related deaths became illicit opioids, mainly heroin and then fentanyl, not prescription opioids.
The study also found no evidence that states with medical marijuana laws experience reductions in the volume of legally distributed opioid analgesics used to treat pain. Even if medical marijuana patients were substituting medical marijuana for opioids in medical marijuana states, these patients did not represent a measurable part of the medical opioid analgesic market.
“While our study finds that medical marijuana dispensaries reduce some of the harms associated with the misuse of opioids, there is little evidence that this is happening because a large number of patients suffering from pain are using marijuana instead of opioid medications,” Pacula said. “Either the patients are continuing to use their opioid pain medications in addition to marijuana, or this patient group represents a small share of the overall medical opioid using population.”
The RAND study was conducted before any any states had begun to allow retail sales of recreational marijuana.
“Our research suggests that the overall story between medical marijuana and opioid deaths is complicated,” Pacula said. “Before we embrace marijuana as a strategy to combat the opioid epidemic, we need to fully understand the mechanism through which these laws may be helping and see if that mechanism still matters in today’s changing opioid crisis.”
Support for the study was provided by the National Institute on Drug Abuse. Other authors of the study are David Powell of RAND and Mireille Jacobson of UC Irvine.
RAND Health is the nation’s largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.
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About the RAND Corporation
The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous.
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RAND Office of Media Relations
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Researcher Spotlight
• Rosalie Liccardo Pacula
Director, Bing Center for Health Economics
Rosalie Liccardo Pacula is a senior economist at the RAND Corporation and a professor at the Pardee RAND Graduate School. She serves as director of RAND’s BING Center for Health Economics, co-director of the RAND Drug Policy Research Center, and associate director of the data core for RAND’s new…
The Drug Enforcement Agency (DEA) has a series of questions parents should ask http://www.getsmartaboutdrugs.com/content/default.aspx?pud=a8bcb6ee-523a-4909-9d76-928d956f3f91

If you suspect that your child has a substance abuse problem, you will have to seek help of some type. You will need a plan of action. The Partnership for a Drug Free America lists 7 Steps to Take and each step is explained at the site. http://www.drugfree.org/intervene

If your child has a substance abuse problem, both you and your child will need help. “One day at a time” is a famous recovery affirmation which you and your child will live the meaning. The road to recovery may be long or short, it will have twists and turns with one step forward and two steps back. In order to reach the goal of recovery, both parent and child must persevere.

Related:

University of Washington study: Heroin use among young suburban and rural non-traditional users on the
https://drwilda.com/2013/10/13/university-of-washington-study-heroin-use-among-young-suburban-and-rural-non-traditional-users-on-the-increase/

Resources

Adolescent Substance Abuse Knowledge Base
http://www.crchealth.com/troubled-teenagers/teenage-substance-abuse/adolescent-substance-abuse/signs-drug-use/

Warning Signs of Teen Drug Abuse
http://parentingteens.about.com/cs/drugsofabuse/a/driug_abuse20.htm?r=et

Is Your Teen Using?
http://www.drugfree.org/intervene

Al-Anon and Alateen
http://www.al-anon.alateen.org/

WEBMD: Parenting and Teen Substance Abuse
http://www.webmd.com/mental-health/tc/teen-substance-abuse-choosing-a-treatment-program-topic-overview

The U.S. Department of Health and Human Services has a very good booklet for families What is Substance Abuse Treatment?
http://store.samhsa.gov/home

The National Institute on Drug Abuse (NIDA) has a web site for teens and parents that teaches about drug abuse NIDA for Teens: The Science Behind Drug Abuse
http://teens.drugabuse.gov/

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Even when food comes to food deserts, lifestyle reigns

10 Feb

Here’s today’s COMMENT FROM AN OLD FART which is actually an update. Moi wrote in ‘Food deserts’: Just how much does personal choice have to do with it?
The Seattle Times published an opinion piece, Op-ed: Bringing relief to food deserts in King County by Anne Vernez Moudon and Adam Drewnowski:

City and county leaders should take more aggressive action to bring relief to food deserts with aggressive development policies and incentives, according to guest columnists Anne Vernez Moudon and Adam Drewnowski. http://seattletimes.com/html/opinion/2019699347_moudondrewnowskiopedxml.html

Here is the definition of a “food desert”:

Definition for food desert:Web definitions: A food desert is a district with little or no access to foods needed to maintain a healthy diet but often served by plenty of fast food… en.wikipedia.org/wiki/Food_desert

That got moi thinking whether the issue isn’t as much personal choice as “food dessert.”

First, there is the New York Times article, Studies Question the Pairing of Food Deserts and Obesity by Gina Kolata:

It has become an article of faith among some policy makers and advocates, including Michelle Obama, that poor urban neighborhoods are food deserts, bereft of fresh fruits and vegetables.
But two new studies have found something unexpected. Such neighborhoods not only have more fast food restaurants and convenience stores than more affluent ones, but more grocery stores, supermarkets and full-service restaurants, too. And there is no relationship between the type of food being sold in a neighborhood and obesity among its children and adolescents.
Within a couple of miles of almost any urban neighborhood, “you can get basically any type of food,” said Roland Sturm of the RAND Corporation, lead author of one of the studies. “Maybe we should call it a food swamp rather than a desert,” he said.
Some experts say these new findings raise questions about the effectiveness of efforts to combat the obesity epidemic simply by improving access to healthy foods. Despite campaigns to get Americans to exercise more and eat healthier foods, obesity rates have not budged over the past decade, according to recently released federal data.
“It is always easy to advocate for more grocery stores,” said Kelly D. Brownell, director of Yale University’s Rudd Center for Food Policy and Obesity, who was not involved in the studies. “But if you are looking for what you hope will change obesity, healthy food access is probably just wishful thinking.”
Advocates have long called for more supermarkets in poor neighborhoods and questioned the quality of the food that is available. And Mrs. Obama has made elimination of food deserts an element of her broader campaign against childhood obesity, Let’s Move, winning praise from Democrats and even some Republicans, and denunciations from conservative commentators and bloggers who have cited it as yet another example of the nanny state….
Some researchers and advocates say that further investigation is still needed on whether grocery stores and chain supermarkets in poor neighborhoods are selling produce that is too costly and of poor quality. “Not all grocery stores are equal,” said John Weidman, deputy executive director of the Food Trust, an advocacy group in Philadelphia. http://www.nytimes.com/2012/04/18/health/research/pairing-of-food-deserts-and-obesity-challenged-in-studies.html?_r=0

http://drwildaoldfart.wordpress.com/tag/op-ed-bringing-relief-to-food-deserts-in-king-county/
Well duh, it appears that lifestyle choice has a great deal to do with good food choices.

Patti Neighmond reported in the NPR story, It Takes More Than A Produce Aisle To Refresh A Food Desert:

In inner cities and poor rural areas across the country, public health advocates have been working hard to turn around food deserts — neighborhoods where fresh produce is scarce, and greasy fast food abounds. In many cases, they’re converting dingy, cramped corner markets into lighter, brighter venues that offer fresh fruits and vegetables. In some cases, they’re building brand new stores.
“The presumption is, if you build a store, people are going to come,” says Stephen Matthews, professor in the departments of sociology, anthropology and demography at Penn State University. To check that notion, he and colleagues from the London School of Hygiene and Tropical Medicine recently surveyed residents of one low-income community in Philadelphia before and after the opening of a glistening new supermarket brimming with fresh produce.
What they’re finding, Matthews says, is a bit surprising: “We don’t find any difference at all. … We see no effect of the store on fruit and vegetable consumption.”
Now, to be fair, the time was short. The store was only open for six months before residents were surveyed. Matthews says most residents knew that the store was there and that it offered healthy food. But only 26 percent said it was their regular “go to” market. And, as might be expected, those who lived close to the store shopped there most regularly.
Matthews says the findings dovetail with other work, and simply point to the obvious: Lots more intervention is needed to change behavior. For one thing, we’re all used to routine, and many of us will just keep shopping where we’ve been shopping, even if a newer, more convenient and bountiful store moves in.
But more than that, he says, many people, particularly in low-income food deserts, just aren’t used to buying or preparing healthy meals — they haven’t had the opportunity, until now.
Alex Ortega, a public health researcher at the University of California, Los Angeles, agrees that providing access to nutritious food is only the first step.
“The next part of the intervention is to create demand,” he says, “so the community wants to come to the store and buy healthy fruits and vegetables and go home and prepare those foods in a healthy way, without lots of fat, salt or sugar.”
Ortega directs a UCLA project that converts corner stores into hubs of healthy fare in low-income neighborhoods of East Los Angeles. He and colleagues work with community leaders and local high school students to help create that demand for nutritious food. Posters and signs promoting fresh fruits and vegetables hang in corner stores, such as the Euclid Market in Boyle Heights, and at bus stops. There are nutrition education classes in local schools, and cooking classes in the stores themselves….
The jury’s still out on whether these conversions of corner stores are actually changing people’s diets and health. The evidence is still being collected. http://www.npr.org/blogs/thesalt/2014/02/10/273046077/takes-more-than-a-produce-aisle-to-refresh-a-food-desert

In other words, much of the obesity problem is due to personal life style choices and the question is whether government can or should regulate those choices.

Personal Responsibility:
There is only one person responsible for your life and the vocation you have chosen. That person is the one you see in the mirror in the morning when you wake up. Don’t blame God, your boss, your parents, your former teachers, your coach, your co-workers or your dog. You and only you are responsible for your work life and what you have achieved. The sooner you accept this notion, the sooner you will begin to make changes that lead to a happier and more productive life and career. http://www.corethemes.com/coreconcepts/

It’s all about ME unless I have to take responsibility for ME. The same brilliant minds who think the government can substitute for family have fostered a single parenthood rate of 70% in the African-American community and about 50% for the population as a whole. Given the child abuse and foster care numbers, this plan hasn’t worked well. Sometimes folks have to be responsible for their choices.

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