Tag Archives: The National Institute on Drug Abuse

Lancet study: Insufficient evidence that medicinal cannabinoids improve mental health

30 Oct

The National Institute on Drug (NIH) Abuse article What is medical marijuana?

The term medical marijuana refers to using the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions. The U.S. Food and Drug Administration (FDA) has not recognized or approved the marijuana plant as medicine.
However, scientific study of the chemicals in marijuana, called cannabinoids, has led to two FDA-approved medications that contain cannabinoid chemicals in pill form. Continued research may lead to more medications.
Because the marijuana plant contains chemicals that may help treat a range of illnesses and symptoms, many people argue that it should be legal for medical purposes. In fact, a growing number of states have legalized marijuana for medical use.
Why isn’t the marijuana plant an FDA-approved medicine?
The FDA requires carefully conducted studies (clinical trials) in hundreds to thousands of human subjects to determine the benefits and risks of a possible medication. So far, researchers haven’t conducted enough large-scale clinical trials that show that the benefits of the marijuana plant (as opposed to its cannabinoid ingredients) outweigh its risks in patients it’s meant to treat.
Read more about the various physical, mental, and behavioral effects of marijuana in our Marijuana DrugFacts.
Medical Marijuana Laws and Prescription Opioid Use Outcomes
A new study underscores the need for additional research on the effect of medical marijuana laws on opioid overdose deaths and cautions against drawing a causal connection between the two. Early research suggested that there may be a relationship between the availability of medical marijuana and opioid analgesic overdose mortality. In particular, a NIDA-funded study published in 2014 found that from 1999 to 2010, states with medical cannabis laws experienced slower rates of increase in opioid analgesic overdose death rates compared to states without such laws.1
A 2019 analysis, also funded by NIDA, re-examined this relationship using data through 2017. Similar to the findings reported previously, this research team found that opioid overdose mortality rates between 1999-2010 in states allowing medical marijuana use were 21% lower than expected. When the analysis was extended through 2017, however, they found that the trend reversed, such that states with medical cannabis laws experienced an overdose death rate 22.7% higher than expected.2 The investigators uncovered no evidence that either broader cannabis laws (those allowing recreational use) or more restrictive laws (those only permitting the use of marijuana with low tetrahydrocannabinol concentrations) were associated with changes in opioid overdose mortality rates.
These data, therefore, do not support the interpretation that access to cannabis reduces opioid overdose. Indeed, the authors note that neither study provides evidence of a causal relationship between marijuana access and opioid overdose deaths. Rather, they suggest that the associations are likely due to factors the researchers did not measure, and they caution against drawing conclusions on an individual level from ecological (population-level) data. Research is still needed on the potential medical benefits of cannabis or cannabinoids.
Read more in our Marijuana Research Report. https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-safe-effective-medicine https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine

Resources:

Marijuana medical benefits – large review finds very few https://www.skepticalraptor.com/skepticalraptorblog.php/marijuana-medical-benefits-large-review/

Marijuana and Cannabinoids | NCCIH
https://nccih.nih.gov/health/marijuana

Science Daily reported the Lancet study: Insufficient evidence that medicinal cannabinoids improve mental health:

Meta-analysis finds inadequate evidence that cannabinoids relieve depression, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis.
The most comprehensive analysis of medicinal cannabinoids and their impact on six mental health disorders — combining 83 studies including 3,000 people — suggests that the use of cannabinoids for mental health conditions cannot be justified based on the current evidence. This is due to a lack of evidence for their effectiveness, and because of the known risks of cannabinoids.
The new findings, published in The Lancet Psychiatry journal, find insufficient evidence medicinal cannabinoids improve disorders overall or their symptoms, although there is a very low quality evidence that pharmaceutical tetrahydrocannabinol (THC) may lead to a small improvement in symptoms of anxiety in individuals with other medical conditions, such as chronic pain or multiple sclerosis.
Medicinal cannabinoids include medicinal cannabis and pharmaceutical cannabinoids, and their synthetic derivatives, THC and cannabidiol (CBD). Around the world, these are increasingly being made available for medicinal purposes (e.g. in the United States, Australia, and Canada), including for the treatment of mental health disorders. However, there are concerns around the adverse effects of this availability, as there is a large body of evidence indicating that non-medicinal cannabis use can increase the occurrence of depression, anxiety, and psychotic symptoms.
Professor Louisa Degenhardt of the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney, Australia, and lead author of the study says: “Our findings have important implications in countries where cannabis and cannabinoids are being made available for medical use. There is a notable absence of high-quality evidence to properly assess the effectiveness and safety of medicinal cannabinoids compared with placebo, and until evidence from randomised controlled trials is available, clinical guidelines cannot be drawn up around their use in mental health disorders.”
She continues: “In countries where medicinal cannabinoids are already legal, doctors and patients must be aware of the limitations of existing evidence and the risks of cannabinoids. These must be weighed when considering use to treat symptoms of common mental health disorders. Those who decide to proceed should be carefully monitored for positive and negative mental health effects of using medicinal cannabinoids.”
This study follows The Lancet Series on Drug Use, which includes a paper on cannabis where the authors assess the current and possible future public health impacts of the legalisation of cannabis production, sale, and use in the Americas. They summarise the overall evidence on medicinal use of cannabinoids, regulation, and how medicinal use may have affected recreational use.
The authors set out to examine the available evidence for all types of medicinal cannabinoids. They included all study designs and investigated the impact on remission from and symptoms of six mental health disorders in adults: depression, anxiety, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, post-traumatic stress disorder (PTSD), and psychosis.
They included published and unpublished studies between 1980 and 2018 and included 83 eligible studies, 40 of which were randomised controlled trials (RCTs) (the others were open-label trials, where participants knew which treatment they were taking). Of the 83 studies, 42 looked at depression (including 23 RCTs), 31 looked at anxiety (17 RCTs), eight looked at Tourette syndrome (two RCTs), three were on ADHD (one RCT), 12 were on PTSD (one RCT), and 11 were on psychosis (six RCTs).
In most RCTs examining depression and anxiety, the primary reason for cannabinoid use was for another medical condition such as chronic non-cancer pain or multiple sclerosis. In the studies looking at the other four disorders, the cannabinoid was used to treat the mental health disorder. Few randomised controlled trials examined the role of pharmaceutical CBD or medicinal cannabis; most looked at THC, with or without CBD.
The authors found that pharmaceutical THC (with or without CBD) improved anxiety symptoms among individuals with other medical conditions (seven studies of 252 people), though this may have been due to improvements in the primary medical condition. The authors suggest further research should explicitly study the effects of cannabinoids on anxiety and depression…. https://www.sciencedaily.com/releases/2019/10/191028213912.htm

Citation:

Insufficient evidence that medicinal cannabinoids improve mental health
Date: October 28, 2019
Source: The Lancet
Summary:
The most comprehensive analysis of medicinal cannabinoids and their impact on six mental health disorders — combining 83 studies including 3,000 people — suggests that the use of cannabinoids for mental health conditions cannot be justified based on the current evidence. This is due to a lack of evidence for their effectiveness, and because of the known risks of cannabinoids.

Journal Reference:
Nicola Black, Emily Stockings, Gabrielle Campbell, Lucy T Tran, Dino Zagic, Wayne D Hall, Michael Farrell, Louisa Degenhardt. Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis. The Lancet Psychiatry, 2019; DOI: 10.1016/S2215-0366(19)30401-8

Here is the press release from the Lancet:

NEWS RELEASE 28-OCT-2019

The Lancet Psychiatry: Insufficient evidence that medicinal cannabinoids improve mental health

Meta-analysis finds inadequate evidence that cannabinoids relieve depression, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis
THE LANCET
Meta-analysis finds inadequate evidence that cannabinoids relieve depression, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis.
The most comprehensive analysis of medicinal cannabinoids and their impact on six mental health disorders – combining 83 studies including 3,000 people – suggests that the use of cannabinoids for mental health conditions cannot be justified based on the current evidence. This is due to a lack of evidence for their effectiveness, and because of the known risks of cannabinoids.
The new findings, published in The Lancet Psychiatry journal, find insufficient evidence medicinal cannabinoids improve disorders overall or their symptoms, although there is a very low quality evidence that pharmaceutical tetrahydrocannabinol (THC) may lead to a small improvement in symptoms of anxiety in individuals with other medical conditions, such as chronic pain or multiple sclerosis.
Medicinal cannabinoids include medicinal cannabis and pharmaceutical cannabinoids, and their synthetic derivatives, THC and cannabidiol (CBD). Around the world, these are increasingly being made available for medicinal purposes (e.g. in the United States, Australia, and Canada), including for the treatment of mental health disorders. However, there are concerns around the adverse effects of this availability, as there is a large body of evidence indicating that non-medicinal cannabis use can increase the occurrence of depression, anxiety, and psychotic symptoms.
Professor Louisa Degenhardt of the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney, Australia, and lead author of the study says: “Our findings have important implications in countries where cannabis and cannabinoids are being made available for medical use. There is a notable absence of high-quality evidence to properly assess the effectiveness and safety of medicinal cannabinoids compared with placebo, and until evidence from randomised controlled trials is available, clinical guidelines cannot be drawn up around their use in mental health disorders.” [1]
She continues: “In countries where medicinal cannabinoids are already legal, doctors and patients must be aware of the limitations of existing evidence and the risks of cannabinoids. These must be weighed when considering use to treat symptoms of common mental health disorders. Those who decide to proceed should be carefully monitored for positive and negative mental health effects of using medicinal cannabinoids.” [1]
This study follows The Lancet Series on Drug Use, which includes a paper on cannabis where the authors assess the current and possible future public health impacts of the legalisation of cannabis production, sale, and use in the Americas. They summarise the overall evidence on medicinal use of cannabinoids, regulation, and how medicinal use may have affected recreational use. [2]
The authors set out to examine the available evidence for all types of medicinal cannabinoids. They included all study designs and investigated the impact on remission from and symptoms of six mental health disorders in adults: depression, anxiety, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, post-traumatic stress disorder (PTSD), and psychosis.
They included published and unpublished studies between 1980 and 2018 and included 83 eligible studies, 40 of which were randomised controlled trials (RCTs) (the others were open-label trials, where participants knew which treatment they were taking). Of the 83 studies, 42 looked at depression (including 23 RCTs), 31 looked at anxiety (17 RCTs), eight looked at Tourette syndrome (two RCTs), three were on ADHD (one RCT), 12 were on PTSD (one RCT), and 11 were on psychosis (six RCTs).
In most RCTs examining depression and anxiety, the primary reason for cannabinoid use was for another medical condition such as chronic non-cancer pain or multiple sclerosis. In the studies looking at the other four disorders, the cannabinoid was used to treat the mental health disorder. Few randomised controlled trials examined the role of pharmaceutical CBD or medicinal cannabis; most looked at THC, with or without CBD.
The authors found that pharmaceutical THC (with or without CBD) improved anxiety symptoms among individuals with other medical conditions (seven studies of 252 people), though this may have been due to improvements in the primary medical condition. The authors suggest further research should explicitly study the effects of cannabinoids on anxiety and depression.
Pharmaceutical THC (with or without CBD) worsened negative symptoms of psychosis (one study, 24 people) and did not significantly affect any other primary outcomes for the mental health disorders examined. It also increased the number of people who had adverse events (ten studies; 1,495 people) and withdrawals due to adverse events (11 studies; 1,621 people) compared with placebo across all mental health disorders examined.
The study highlights the limited evidence and the low quality of the evidence that exists around using cannabinoids for treatment of mental health conditions. There is a need for high-quality research to understand the effects of different cannabinoids on a range of outcomes for people with mental health disorders.
Professor Degenhardt says: “Cannabinoids are often advocated as a treatment for various mental health conditions. Countries that allow medicinal cannabinoid use will probably see increased demand for such use. Clinicians and consumers need to be aware of the low quality and quantity of evidence for the effectiveness of medicinal cannabinoids in treating mental health disorders and the potential risk of adverse events. Given the likely interest but scant evidence to guide patient and clinician decisions around cannabinoids for mental health, there is an urgent need for randomised controlled trials to inform whether there are benefits of cannabinoids for these indications.” [1]
The authors highlight that their analysis and conclusions are limited by the small amount of available data, small study sizes, and the differences in findings between small studies. There is no recommended approach for addressing these issues in systematic reviews, but they tried to minimise them by keeping the focus of the review narrow. They also note that most studies are based on pharmaceutical cannabinoids, rather than medicinal cannabis, but plant products are most often used by those taking cannabinoids for medicinal purposes in the USA.
In a related Comment article, Professor Deepak Cyril D’Souza of Yale University School of Medicine, USA, says: “The process of drug development in modern medicine is to first demonstrate efficacy and safety in clinical trials before using the drug clinically. With cannabinoids, it seems that the cart (use) is before the horse (evidence). For cannabinoids to be used in the treatment of psychiatric disorders they should be tested in RCTs and subjected to the same regulatory approval process as other prescription medications.”
###
NOTES TO EDITORS
This study was funded by Australian Therapeutic Goods Administration, the Commonwealth Department of Health, Australia, Australian National Health and Medical Research Council and the US National Institutes of Health. It was conducted by researchers from the National Drug and Alcohol Research Centre, UNSW, the University of Brisbane, Australia and King’s College London, UK.
The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com
[1] Quote direct from author and cannot be found in the text of the Article.
[2] Paper available here (begins page 29): http://www.thelancet-press.com/embargo/EMBARGOED-druguseseries.pdf
A press release for this report is also available.
Peer-reviewed / Meta-analysis / People
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The Centers for Disease Control and Addiction wrote in Marijuana: How Can It Affect Your Health?

Marijuana is the most commonly used illegal drug in the United States, with 37.6 million users in the past year,1 and marijuana use may have a wide range of health effects on the body and brain. Click on the sections below to learn more about how marijuana use can affect your health.
ADDICTION
About 1 in 10 marijuana users will become addicted. For people who begin using before the age of 18, that number rises to 1 in 6. 1-3
Some of the signs that someone might be addicted include:
• Unsuccessful efforts to quit using marijuana.
• Giving up important activities with friends and family in favor of using marijuana.
• Using marijuana even when it is known that it causes problems fulfilling everyday jobs at home, school or work.4
People who are addicted to marijuana may also be at a higher risk of other negative consequences of using the drug, such as problems with attention, memory, and learning. Some people who are addicted need to smoke more and more marijuana to get the same high. It is also important to be aware that the amount of tetrahydrocannabinol (THC) in marijuana (i.e., marijuana potency or strength) has increased over the past few decades. The higher the THC content, the stronger the effects on the brain. In addition, some methods of using marijuana (e.g., dabbing, edibles) may deliver very high levels of THC to the user.5 Researchers do not yet know the full extent of the consequences when the body and brain (especially the developing brain) are exposed to high concentrations of THC or how recent increases in potency affect the risk of someone becoming addicted. 5
References
1. Lopez-Quintero, C, et al. (2011). Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend. 115(1-2): p. 120-30.
2. Hall, W, Degenhardt L. (2009). Adverse health effects of non-medical cannabis use. Lancet. 374(9698): p. 1383-91.
3. Budney, AJ, Sargent JD, and Lee, DC. (2015). Vaping cannabis (marijuana): parallel concerns to e-cigs? Addiction. 110(11): p. 1699-704.
4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
5. National Institute on Drug Abuse. Is marijuana addictive?external icon (2017) Rockville, MD: National Institutes of Health, National Institute on Drug Abuse.
BRAIN HEALTH
Marijuana use directly affects the brain — specifically the parts of the brain responsible for memory, learning, attention, decision making, coordination, emotions, and reaction time.1
What are the short-term effects of marijuana on the brain?
Heavy users of marijuana can have short-term problems with attention, memory, and learning, which can affect relationships and mood.
What are the long-term effects of marijuana on the brain?
Marijuana also affects brain development. When marijuana users begin using as teenagers, the drug may reduce attention, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions.
Marijuana’s effects on these abilities may last a long time or even be permanent. This means that someone who uses marijuana may not do as well in school and may have trouble remembering things. 1-3
The impact depends on many factors and is different for each person. It also depends on the amount of tetrahydrocannabinol (THC) in marijuana (i.e., marijuana potency or strength), how often it is used, the age of first use, and whether other substances (e.g., tobacco and alcohol) are used at the same time.
Marijuana and the developing brain
Developing brains, like those in babies, children, and teenagers are especially susceptible to the hurtful effects of marijuana. Although scientists are still learning about these effects of marijuana on the developing brain, studies show that marijuana use by mothers during pregnancy may be linked to problems with attention, memory, problem-solving skills, and behavior problems in their children. 3-7
References
1. Batalla A, Bhattacharyya S, Yücel M, et al. (2013). Structural and functional imaging studies in chronic cannabis users: a systematic review of adolescent and adult findings. PloS One. 8(2):e55821. doi:10.1371/journal.pone.0055821.
2. Filbey, FM, et al., Long-term effects of marijuana use on the brain. (2014) Proc Natl Acad Sci USA. 111(47): p. 16913-8.
3. Goldschmidt, L, et al. (2002). Richardson, Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicol Teratol. 22(3): p. 325-36.
4. Fried, PA, Watkinson, B, and Gray, R. Differential effects on cognitive functioning in 9- to 12-year olds prenatally exposed to cigarettes and marihuana. Neurotoxicol Teratol, 1998. 20(3): p. 293-306.
5. Leech, SL, et al., (1999). Prenatal substance exposure: effects on attention and impulsivity of 6-year-olds. Neurotoxicol Teratol. 21(2): p. 109-18.
6. Goldschmidt, L, et al., (2008) Prenatal marijuana exposure and intelligence test performance at age 6. J Am Acad Child Adolesc Psychiatry. 47(3): p. 254-63.
7. El Marroun, H, et al., (2011). Intrauterine cannabis exposure leads to more aggressive behavior and attention problems in 18-month-old girls. Drug Alcohol Depend. 118(2-3): p. 470-4.
CANCER
Marijuana and cannabinoids (the active chemicals in marijuana that cause drug-like effects throughout the body, including the central nervous system and the immune system). The main active cannabinoid in marijuana is delta-9-THC. Another active cannabinoid is cannabidiol (CBD), which may relieve pain and lower inflammation without causing the “high” of delta-9-THC. Although marijuana and cannabinoids have been studied with respect to managing side effects of cancer and cancer therapies, there are no ongoing clinical trials of marijuana or cannabinoids in treating cancer in people.9 Studies so far have not shown that cannabinoids help control or cure the disease.2 And like many other drugs, marijuana can cause side effects and complications.
Relying on marijuana alone as treatment or for managing side effects while avoiding or delaying conventional medical care for cancer may have serious health consequences.2
How can marijuana affect symptoms of cancer?
Studies of man-made forms of the chemicals found in the marijuana plant can be helpful in treating nausea and vomiting from cancer chemotherapy.1 Studies have found that marijuana can be helpful in treating neuropathic pain (pain caused by damaged nerves).1
At this time, there is not enough evidence to recommend that patients inhale or ingest marijuana as a treatment for cancer-related symptoms or side effects of cancer therapy.
Is there a link between marijuana and cancer?
Smoked marijuana delivers THC and other cannabinoids to the body, but it also delivers harmful substances to users and those close by, including many of the same substances found in tobacco smoke, which are harmful to the lungs and cardiovascular system.3
Researchers have found limited evidence of an association between current, frequent, or chronic marijuana smoking and testicular cancer (non-seminoma-type).4
Because marijuana plants come in different strains with different levels of active chemicals, it can make each user’s experience very hard to predict. More research is needed to understand the full impact of marijuana use on cancer.
References
1. National Academies of Sciences E, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for researchexternal icon. Washington, D.C.
2. National Cancer Institute. (2017). Cannabis and Cannabinoids (PDQ®)–Patient Versionexternal icon. Rockville, MD: National Institutes of Health, National Cancer Institute.
3. U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General pdf icon[PDF – 36MB]external icon. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
4. Gurney, J, et al. (2015). Cannabis exposure and risk of testicular cancer: a systematic review and meta-analysis. BMC Cancer. 15: p. 897.
CHRONIC PAIN
Even though pain management is one of the most common reasons people use medical marijuana in the U.S., there is limited evidence that marijuana works to treat most types of chronic pain.
A few studies have found that marijuana can be helpful in treating neuropathic pain (pain caused by damaged nerves). 1 However, more research is needed to know if marijuana is any better or any worse than other options for managing chronic pain.
References
1. National Academies of Sciences E, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for researchexternal icon. Washington, D.C.
HEART HEALTH
Using marijuana makes the heart beat faster.1 It could also lead to increased risk of stroke and heart disease. 2-6 However, most of the scientific studies linking marijuana to heart attacks and strokes are based on reports from people who smoked it. Smoked marijuana delivers THC and other cannabinoids to the body, but it also delivers harmful substances to users and those close by, including many of the same substances found in tobacco smoke, which are harmful to the lungs and cardiovascular system. 3 So it’s hard to separate the effects of the compounds in marijuana on the cardiovascular system from the hazards posed by the irritants and other chemicals contained in the smoke. More research is needed to understand the full impact of marijuana use on the circulatory system to determine if marijuana use leads to higher risk of death from these causes.
References
1. Sidney, S. (2002) Cardiovascular consequences of marijuana use. J Clin Pharmacol. 42(11 Suppl): p. 64S-70S.
2. Wolff, V, et al. (2013). Cannabis-related stroke: myth or reality? Stroke. 44(2): p. 558-63.
3. Wolff, V, et al. (2015). Characteristics and Prognosis of Ischemic Stroke in Young Cannabis Users Compared With Non-Cannabis Users. J Am Coll Cardiol. 66(18): p. 2052-3.
4. Franz, CA and Frishman, WH. (2016) Marijuana Use and Cardiovascular Disease. Cardiol Rev. 24(4): p. 158-62.
5. Rumalla, K, Reddy, AY, and Mittal, MK. (2016). Recreational marijuana use and acute ischemic stroke: A population-based analysis of hospitalized patients in the United States. J Neurol Sci. 364: p. 191-6.
6. Rumalla, K, Reddy, AY, and Mittal, MK. (2016). Association of Recreational Marijuana Use with Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis. 25(2): p. 452-60.
LUNG HEALTH
How marijuana affects lung health is determined by how it’s consumed. In many cases, marijuana is smoked in the form hand-rolled cigarettes (joints), in pipes or water pipes (bongs), in bowls, or in blunts—emptied cigars that have been partly or completely refilled with marijuana. Smoked marijuana, in any form, can harm lung tissues and cause scarring and damage to small blood vessels. 1-2 Smoke from marijuana contains many of the same toxins, irritants, and carcinogens as tobacco smoke. 3 Smoking marijuana can also lead to a greater risk of bronchitis, cough, and phlegm production. 4-8 These symptoms generally improve when marijuana smokers quit.9-10
Secondhand marijuana smoke
The known health risks of secondhand exposure to cigarette smoke—to the heart or lungs, for instance—raise questions about whether secondhand exposure to marijuana smoke poses similar health risks. While there is very little data on the health consequences of breathing secondhand marijuana smoke, there is concern that it could cause harmful health effects, including among children.
Recent studies have found strong associations between those who said there was someone in the home who used marijuana or a caretaker who used marijuana and the child having detectable levels of THC — the psychoactive ingredient in marijuana. 5,11 Children exposed to the psychoactive compounds in marijuana are potentially at risk for negative health effects, including developmental problems for babies whose mothers used marijuana while pregnant. 8 Other research shows that marijuana use during adolescence can impact the developing teenage brain and cause problems with attention, motivation, and memory.12
References
1. Tashkin, DP. (2013) Effects of marijuana smoking on the lung. Ann Am Thorac Soc. 10(3): p. 239-47.
2. Moir, D, et al. (2008). A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chem Res Toxicol. 21(2): p. 494-502.
3. U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General pdf icon[PDF – 36MB]external icon. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
4. Aldington, S, et al., Effects of cannabis on pulmonary structure, function and symptoms. Thorax, 2007. 62(12): p. 1058-63.
5. Moore, C, et al. (2011). Cannabinoids in oral fluid following passive exposure to marijuana smoke. Forensic Sci Int. 212(1-3): p. 227-30.
6. Tan, WC, et al. (2009). Marijuana and chronic obstructive lung disease: a population-based study. CMAJ. 180(8): p. 814-20.
7. Taylor, DR, et al. (200). The respiratory effects of cannabis dependence in young adults. Addiction. 95(11): p. 1669-77.
8. National Academies of Sciences E, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for researchexternal icon. Washington, D.C.
9. Hancox, RJ, et al. (2015). Effects of quitting cannabis on respiratory symptoms. Eur Respir J, 2015. 46(1): p. 80-7.
10. Tashkin, DP, Simmons MS, and Tseng, CH. (2012). Impact of changes in regular use of marijuana and/or tobacco on chronic bronchitis. COPD. 9(4): p. 367-74.
11. Wilson KM, Torok MR, Wei B, et al. (2017). Detecting biomarkers of secondhand marijuana smoke in young children. Pediatr Res. 81:589–592.
12. Broyd, SJ, et al. (2016). Acute and Chronic Effects of Cannabinoids on Human Cognition-A Systematic Review. Biol Psychiatry. 79(7): p. 557-67.
MENTAL HEALTH
Marijuana use, especially frequent (daily or near daily) use and use in high doses, can cause disorientation, and sometimes cause unpleasant thoughts or feelings of anxiety and paranoia. 1
Marijuana users are significantly more likely than nonusers to develop temporary psychosis (not knowing what is real, hallucinations and paranoia) and long-lasting mental disorders, including schizophrenia (a type of mental illness where people might see or hear things that aren’t really there). 2
Marijuana use has also been linked to depression and anxiety, and suicide among teens. However, it is not known whether this is a causal relationship or simply an association.
References
1. National Academies of Sciences E, and Medicine. (2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for researchexternal icon. Washington, D.C.
2. Volkow ND, Swanson JM, Evins AE, et al. (2016). Effects of cannabis use on human behavior, including cognition, motivation, and psychosis: a review. JAMA Psychiatry. 73(3):292-297. doi:10.1001/jamapsychiatry.2015.3278.
POISONING
Edibles, or food and drink products infused with marijuana and eaten, have some different risks than smoking marijuana, including a greater risk of poisoning. Unlike smoked marijuana, edibles can:
• Take from 30 minutes to 2 hours to take effect. So some people eat too much, which can lead to poisoning and/or serious injury.
• Cause effects that last longer than expected depending on the amount, the last food eaten, and medications or alcohol used at the same time.
• Be very difficult to measure. The amount of THC, the active ingredient in marijuana, is very difficult to measure and is often unknown in edible products. Many users can be caught off-guard by the strength and long-lasting effects of edibles.
It is also important to remember that marijuana affects children differently than adults. Since marijuana has become legal in some states, children have accidentally eaten marijuana products that looked like candy and treats, which made them sick enough to need emergency medical care. 3
If you use marijuana products, keep them in childproof containers and out of the reach of children. For additional questions, you can contact your health care provider, your health department, the Poison Helplineexternal icon at 1-800-222-1222, or 911 if it’s an emergency.
RISK OF USING OTHER DRUGS
The concept of marijuana as a “gateway drug”—where using marijuana leads a person to use other drugs—generates a lot of disagreement. Researchers haven’t found a definite answer yet. 1-2 However, most people who use marijuana do not go on to use other, “harder” drugs. 1
It is important to remember that people of any age, sex, or economic status can become addicted to marijuana or other drugs. Things that can affect the likelihood of substance use include:
• Family history.
• Having another mental health illness (such as anxiety or depression).
• Peer pressure.
• Loneliness or social isolation.
• Lack of family involvement.
• Drug availability.
• Socioeconomic status. 2
References
1. National Institute on Drug Abuse. Is marijuana a gateway drug? (2017). Rockville, MD: National Institutes of Health, National Institute on Drug Abuse.
2. Robertson EB, David SL, Rao SA. (2003) Preventing Drug Use Among Children and Adolescents. A Research-Based Guide for Parents, Educators, and Community Leaders pdf icon[PDF-725KB]external icon. National Institute on Drug Abuse, 2nd edn. NIH Publication no. 04-4212 (A). Bethesda, MD: US Department of Health and Human Services.
3. Colorado Department of Public Health and Environment (2017) Monitoring Health Concerns Related to Marijuana in Colorado: 2016external icon.
Reference
1. Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Healthexternal icon. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
2. Batalla A, Bhattacharyya S, Yücel M, et al. (2013). Structural and functional imaging studies in chronic cannabis users: a systematic review of adolescent and adult findings. PloS One. 8(2):e55821. doi:10.1371/journal.pone.0055821. https://www.cdc.gov/marijuana/health-effects.html

THE JURY IS OUT ON THE MEDICAL USES OF MARIJUANA.

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University of California Davis study: A breath test for opioids

6 Oct

The National Institute on Drug Abuse provides information on opioids:

Brief Description
Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.
• Summary
• All opioids are chemically related and interact with opioid receptors on nerve cells in the body and brain. Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused (taken in a different way or in a larger quantity than prescribed, or taken without a doctor’s prescription). Regular use—even as prescribed by a doctor—can lead to dependence and, when misused, opioid pain relievers can lead to addiction, overdose incidents, and deaths.
• An opioid overdose can be reversed with the drug naloxone when given right away. Improvements have been seen in some regions of the country in the form of decreasing availability of prescription opioid pain relievers and decreasing misuse among the Nation’s teens. However, since 2007, overdose deaths related to heroin have been increasing. Fortunately, effective medications exist to treat opioid use disorders including methadone, buprenorphine, and naltrexone.
• A NIDA study found that once treatment is initiated, both a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid addiction. However, naltrexone requires full detoxification, so initiating treatment among active users was more difficult. These medications help many people recover from opioid addiction.
• NIDA’s Role in the NIH HEAL Initiative℠ https://www.drugabuse.gov/drugs-abuse/opioids/nidas-role-in-nih-heal-initiative
• Prescription Opioids https://www.drugabuse.gov/publications/drugfacts/prescription-opioids
• Heroin https://www.drugabuse.gov/drugs-abuse/heroin
• Fentanyl https://www.drugabuse.gov/drugs-abuse/fentanyl
• Opioid Research Findings Funded by NIDA
https://www.drugabuse.gov/drugs-abuse/opioids

Opioids are powerful drugs and can be abused.

Resources:
What Is an Opioid? – Teens – Drug Information
https://teens.drugabuse.gov/blog/post/what-opioid

What are opioids and why are they dangerous? – Mayo Clinic
https://www.mayoclinic.org/…/expert-answers/what-are-opioids/faq-20381270

The American Society of Anesthesiologists has a concise description of opioid abuse at their site:

Opioid Abuse
Opioids are highly addictive, and opioid abuse has become a national crisis in the United States. Statistics highlight the severity of the epidemic, with the National Institute on Drug Abuse reporting that more than 2 million Americans abuse opioids and that more than 90 Americans die by opioid overdose every day, on average.
Why do people become addicted to opioids?
Opioids can make your brain and body believe the drug is necessary for survival. As you learn to tolerate the dose you’ve been prescribed, you may find that you need even more medication to relieve the pain or achieve well-being, which can lead to dependency. Addiction takes hold of our brains in several ways — and is far more complex and less forgiving than many people realize.
How can you avoid addiction to opioids?
If you or a loved one is considering taking opioids to manage pain, it is vital to talk to a physician anesthesiologist or other pain medicine specialist about using them safely and exploring alternative options if needed. Learn how to work with your physician anesthesiologist or another physician to use opioids more wisely and safely and explore what pain management alternatives might work for you.
What are the signs of an addiction?
People addicted to drugs may change their behavior. Possible signs include:
• Mixing with different groups of people or changing friends
• Spending time alone and avoiding time with family and friends
• Losing interest in activities
• Not bathing, changing clothes or brushing their teeth
• Being very tired and sad
• Eating more or less than usual
• Being overly energetic, talking fast and saying things that don’t make sense
• Being nervous or cranky
• Quickly changing moods
• Sleeping at odd hours
• Missing important appointments
• Getting into trouble with the law
• Attending work or school on an erratic schedule
• Experiencing financial hardship
https://www.asahq.org/whensecondscount/pain-management/opioid-treatment/opioid-abuse/

The University of California Davis has developed a breath test for opioids.

Science Daily reported in A breath test for opioids:

A test to detect opioid drugs in exhaled breath has been developed by engineers and physicians at the University of California, Davis. A breath test could be useful in caring for chronic pain patients as well as for checking for illegal drug use.
“There are a few ways we think this could impact society,” said Professor Cristina Davis, chair of the Department of Mechanical and Aerospace Engineering at UC Davis, who led the research along with Professor Michael Schivo from the UC Davis Medical Center. The work is described in a paper published in the Journal of Breath Research Oct. 3.
Doctors and nurses treating chronic pain may need to monitor patients to make sure they are taking their drugs correctly, that their prescribed drugs are being metabolized properly and that they are not taking additional medications. Blood tests are the gold standard: a reliable, noninvasive test would be a useful alternative.
Collecting droplets from breath
For the test developed by postdoctoral researcher Eva Borras, Davis and colleagues, subjects breathe normally into a specialized collection device. Droplets in breath condense and are stored in a freezer until testing. Davis’ lab uses mass spectrometry to identify compounds in the samples.
The researchers tested the technique in a small group of patients receiving infusions of pain medications including morphine and hydromorphone, or oral doses of oxycodone, at the UC Davis Medical Center. They were therefore able to compare opioid metabolites in breath with both blood samples and the doses given to patients.
“We can see both the original drug and metabolites in exhaled breath,” Davis said.
Fully validating the breath test will require more data from larger groups of patients, she said. Davis’ laboratory is working toward real-time, bedside testing…. https://www.sciencedaily.com/releases/2019/10/191004105645.htm

Citation:

A breath test for opioids
Date: October 4, 2019
Source: University of California – Davis
Summary:
A test to detect opioid drugs in exhaled breath has been developed by engineers and physicians. A breath test could be useful in caring for chronic pain patients as well as for checking for illegal drug use.

Journal Reference:
Eva Borras, Andy Cheng, Ted Wun, Kristen L Reese, Matthias Frank, Michael Schivo, Cristina E Davis. Detecting opioid metabolites in exhaled breath condensate (EBC). Journal of Breath Research, 2019; 13 (4): 046014 DOI: 10.1088/1752-7163/ab35fd

Here is the press release from University of California Davis:

A Breath Test for Opioids
By Andy Fell on October 3, 2019 in Human & Animal Health
UC Davis researchers have developed a method for detecting opioid drugs and drug metabolites in breath. The test could be useful for management of patients with chronic pain, as well as for detecting illegal opioid use. (Credit: Charles Wollertz/Getty Images)
A test to detect opioid drugs in exhaled breath has been developed by engineers and physicians at the University of California, Davis. A breath test could be useful in caring for chronic pain patients as well as for checking for illegal drug use.
“There are a few ways we think this could impact society,” said Professor Cristina Davis, chair of the Department of Mechanical and Aerospace Engineering at UC Davis, who led the research along with Professor Michael Schivo from the UC Davis Medical Center. The work is described in a paper published in the Journal of Breath Research Oct. 3.
Doctors and nurses treating chronic pain may need to monitor patients to make sure they are taking their drugs correctly, that their prescribed drugs are being metabolized properly and that they are not taking additional medications. Blood tests are the gold standard: a reliable, noninvasive test would be a useful alternative.
Collecting droplets from breath
For the test developed by postdoctoral researcher Eva Borras, Davis and colleagues, subjects breathe normally into a specialized collection device. Droplets in breath condense and are stored in a freezer until testing. Davis’ lab uses mass spectrometry to identify compounds in the samples.
The researchers tested the technique in a small group of patients receiving infusions of pain medications including morphine and hydromorphone, or oral doses of oxycodone, at the UC Davis Medical Center. They were therefore able to compare opioid metabolites in breath with both blood samples and the doses given to patients.
“We can see both the original drug and metabolites in exhaled breath,” Davis said.
Fully validating the breath test will require more data from larger groups of patients, she said. Davis’ laboratory is working toward real-time, bedside testing.
Other authors on the paper include graduate student Andy Cheng, UC Davis forensic science program; Ted Wun, Department of Internal Medicine; Kristen Reese and Matthias Frank, Lawrence Livermore National Laboratory; and Michael Schivo, UC Davis School of Medicine and VA Northern California Health System.
Davis’ laboratory is working on a variety of applications for detecting small amounts of chemicals, especially in air and exhaled breath. Other projects include diagnosing influenza in people and citrus greening disease in fruit trees.
The work was supported by grants from the UC Davis Medical Center’s Collaborative for Diagnostic Innovation, the U.S. Department of Energy and the NIH.
Media contact(s)
Cristina Davis, Mechanical and Aerospace Engineering, 530-754-9004, cedavis@ucdavis.edu
Andy Fell, News and Media Relations, 530-752-4533, ahfell@ucdavis.edu
Media Resources
Read the paper (Journal of Breath Research) https://iopscience.iop.org/article/10.1088/1752-7163/ab35fd

The National Institute on Drug Abuse defines the opioid crisis:

Revised January 2019
Every day, more than 130 people in the United States die after overdosing on opioids.1 The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis that affects public health as well as social and economic welfare. The Centers for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.2
How did this happen?
In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive.3,4 Opioid overdose rates began to increase. In 2017, more than 47,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid.1 That same year, an estimated 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, and 652,000 suffered from a heroin use disorder (not mutually exclusive).5
What do we know about the opioid crisis?
• Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.6
• Between 8 and 12 percent develop an opioid use disorder.6
• An estimated 4 to 6 percent who misuse prescription opioids transition to heroin.7–9
• About 80 percent of people who use heroin first misused prescription opioids.7
• Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states.10
• The Midwestern region saw opioid overdoses increase 70 percent from July 2016 through September 2017.10
• Opioid overdoses in large cities increase by 54 percent in 16 states.10

This issue has become a public health crisis with devastating consequences including increases in opioid misuse and related overdoses, as well as the rising incidence of neonatal abstinence syndrome due to opioid use and misuse during pregnancy. The increase in injection drug use has also contributed to the spread of infectious diseases including HIV and hepatitis C. As seen throughout the history of medicine, science can be an important part of the solution in resolving such a public health crisis.
https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

 

“The mentality, thought system and relationships that got you into addiction will keep you there unless you disentangle yourself from them.”

Oche Otorkpa,
The Night Before I killed Addiction

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Journal of the American Medical Association special report: CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016

15 Mar

HELPGUIDE.ORG defines substance abuse and also describes some of the traits of a substance abuser.

Drug abuse, also known as substance abuse, involves the repeated and excessive use of chemical substances to achieve a certain effect. These substances may be “street” or “illicit” drugs, illegal due to their high potential for addiction and abuse. They also may be drugs obtained with a prescription, used for pleasure rather than for medical reasons.
Different drugs have different effects. Some, such as cocaine or methamphetamine, may produce an intense “rush” and initial feelings of boundless energy. Others, such as heroin, benzodiazepines or the prescription oxycontin, may produce excessive feelings of relaxation and calm. What most drugs have in common, though, is overstimulation of the pleasure center of the brain. With time, the brain’s chemistry is actually altered to the point where not having the drug becomes extremely uncomfortable and even painful. This compelling urge to use, addiction, becomes more and more powerful, disrupting work, relationships, and health. http://helpguide.org/mental/drug_substance_abuse_addiction_signs_effects_treatment.htm

In a 2014 article the National Institute on Drug Abuse took a cautious approach in linking pain killers and drug abuse.

The National Institute on Drug Abuse wrote in Abuse of Prescription Pain Medications Risks Heroin Use:

Text Description of Infographic

In 2010 almost 1 in 20 adolescents and adults – 12 million people – used prescription pain medication when it was not prescribed for them or only for the feeling it caused.  While many believe these drugs are not dangerous because they can be prescribed by a doctor, abuse often leads to dependence.  And eventually, for some, pain medication abuse leads to heroin.

Top Figure: 1 in 15 people who take non medical prescription pain relievers will try heroin within 10 years.

Left  Graph: Number of people who abused or were dependent on pain medications and percentage of them that use heroin.  Pie charts show in 2004 1.4 million people abused or were dependent on pain medications and 5% used heroin. In 2010, 1.9 million people abused or were dependent on pain medications and 14% used heroin.

Right Top Graph:  Heroin users are 3 times as likely to be dependent.  14% of non medical prescription pain reliever users are dependent. Yet, 54% of heroin users are dependent.

Right Bottom Graph:  Heroin emergency room admissions are increasing.  In 2005 there were less than 200,000 emergency room visits related to heroin. By 2011 this number had increased to almost 260,000….https://www.drugabuse.gov/related-topics/trends-statistics/infographics/abuse-prescription-pain-medications-risks-heroin-use

The CDC issued new recommendations regarding prescribing pain medication.

Kimberly Leonard of U.S. News wrote in Getting a Painkiller from a Doctor Is About to Get Harder:

Government health officials on Tuesday provided strategies for primary care doctors who treat patients suffering from chronic pain. Among the recommendations: to use urine drug testing before prescribing highly addictive painkillers like oxycontin, codeine and morphine.

The guidance, put forth by the Centers for Disease Control and Prevention, is part of the government’s response to the epidemic of people dying from opioid overdoses, which include prescription painkillers but also the drug’s cheaper alternative, heroin. Data from the CDC show that in 2014 these deaths surpassed car accidents as the No. 1 cause of injury-related death.

For the most part, the CDC recommends limiting opioid prescriptions to people who have cancer, are receiving end-of-life or palliative care, or are suffering with serious illnesses. Primary care doctors have been in part responsible for the surge in addiction: Since 1999, the prescribing and sales of opioids has quadrupled, and primary care doctors account for nearly half of these prescriptions….                                                                                                           http://www.usnews.com/news/articles/2016-03-15/cdc-issues-guidance-on-prescription-painkillers

Citation:

Special Communication | March 15, 2016

CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 FREE ONLINE FIRST

Deborah Dowell, MD, MPH1; Tamara M. Haegerich, PhD1; Roger Chou, MD1

[+] Author Affiliations

JAMA. Published online March 15, 2016. doi:10.1001/jama.2016.1464

Text Size: A A A

Article

Tables

Supplemental Content

References

ABSTRACT

ABSTRACT | INTRODUCTION | GUIDELINE DEVELOPMENT PROCESS | RECOMMENDATIONS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES

Importance  Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose.

Objective  To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care.

Process  The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category.

Evidence Synthesis  Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (≥1 year) benefit of opioids for chronic pain. Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent effects.

Recommendations  There are 12 recommendations. Of primary importance, nonopioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks. Before starting opioids, clinicians should establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks. When opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concurrent opioids and benzodiazepines whenever possible. Clinicians should evaluate benefits and harms of continued opioid therapy with patients every 3 months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages. For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone.

Conclusions and Relevance  The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.

Here is the recommendation for patients from LeShaundra Cordier Scott, MPH, CHES; Sarah Lewis, MPH, CHES:

RECOMMENDATIONS FOR SAFER AND MORE EFFECTIVE PAIN MANAGEMENT

A JAMA article was published online on March 15, 2016, describing a new Centers for Disease Control and Prevention opioid prescribing guideline for chronic pain. The guideline provides recommendations based on available science for safer, more effective treatment of chronic pain outside of active cancer, palliative care, and end-of-life care.

The recommendations ask health care practitioners to

  • Use nonopioid medications and other therapies such as physical therapy instead of or in combination with opioids.
  • Prescribe the lowest effective dosage of opioids to reduce risks of opioid use disorder and overdose.
  • Discuss potential benefits and harms of opioids with patients.
  • Assess improvements in pain and function regularly.
  • Use tools such as urine drug tests and prescription drug monitoring programs to inform themselves about patients’ other medications that increase risk.
  • Monitor patients for signs of whether opioid use disorder might be developing and arrange treatment if needed

 

WHAT YOU CAN DO

 

If you have chronic pain, be sure to

  • Consider ways to manage your pain that do not include opioids, such as physical therapy, exercise, nonopioid medications, and cognitive behavioral therapy.
  • Make the most informed decision with your doctor.
  • Never take opioids in greater amounts or more often than prescribed.
  • Avoid taking opioids with alcohol and other substances or medications you have not discussed with your doctor.

If you or someone close to you has an addiction to pain medication, talk to your doctor or contact the Substance Abuse and Mental Health Services Administration’s treatment help line at (800) 662-HELP.

For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Spanish translations are available in the supplemental content tab.

ARTICLE INFORMATION

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Published Online: March 15, 2016. doi:10.1001/jama.2016.3224.

Here is the press release from the American Medical Association:

March 15, 2016

AMA Responds to CDC Guidelines on Opioids

For immediate release:
March 15, 2016

CHICAGO – In response to the Centers for Disease Control and Prevention (CDC) guidelines issued today, the American Medical Association (AMA) noted its shared goal of reducing harm from opioid abuse and seeking solutions to end this public health epidemic and applauds the agency for making the issue a high priority. As with any guideline development of this magnitude, we appreciated the opportunity to add the voice of patients and physicians.

“While we are largely supportive of the guidelines, we remain concerned about the evidence base informing some of the recommendations, conflicts with existing state laws and product labeling, and possible unintended consequences associated with implementation, which includes access and insurance coverage limitations for non-pharmacologic treatments, especially comprehensive care, and the potential effects of strict dosage and duration limits on patient care,” said Patrice A. Harris, MD, the AMA board chair-elect and chair of the AMA Task Force to Reduce Opioid Abuse.

“We know this is a difficult issue that doesn’t have easy solutions and if these guidelines help reduce the deaths resulting from opioids, they will prove to be valuable. If they produce unintended consequences, we will need to mitigate them. They are not the final word. More needs to be done, and we plan to continue working at the state and federal level to engage policy makers to take steps that will help end this epidemic.”

###

Media Contact:
Jack Deutsch
AMA Media & Editorial
202-789-7442
Jack.Deutsch@ama-assn.org

If you or a member of your family is prescribed pain medication, the course of treatment should follow CDC recommendations.

Where information leads to Hope. © Dr. Wilda.com

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American Academy of Pediatrics opposes drug testing in schools

5 Apr

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 The National Council on Alcohol and Drug Dependence lists Signs and Symptoms:

1. Physical and health warning signs of drug abuse
• Eyes that are bloodshot or pupils that are smaller or larger than normal.
• Frequent nosebleeds–could be related to snorted drugs (meth or cocaine).
• Changes in appetite or sleep patterns. Sudden weight loss or weight gain.
• Seizures without a history of epilepsy.
• Deterioration in personal grooming or physical appearance.
• Injuries/accidents and person won’t or can’t tell you how they got hurt.
• Unusual smells on breath, body, or clothing.
• Shakes, tremors, incoherent or slurred speech, impaired or unstable coordination.

2. Behavioral signs of drug abuse
• Drop in attendance and performance at work or school; loss of interest in extracurricular activities, hobbies, sports or exercise; decreased motivation.
• Complaints from co-workers, supervisors, teachers or classmates.
• Unusual or unexplained need for money or financial problems; borrowing or stealing; missing money or valuables.
• Silent, withdrawn, engaging in secretive or suspicious behaviors.
• Sudden change in relationships, friends, favorite hangouts, and hobbies.
• Frequently getting into trouble (arguments, fights, accidents, illegal activities).

3. Psychological warning signs of drug abuse
• Unexplained change in personality or attitude.
• Sudden mood changes, irritability, angry outbursts or laughing at nothing.
• Periods of unusual hyperactivity or agitation.
• Lack of motivation; inability to focus, appearing lethargic or “spaced out.”
• Appearing fearful, withdrawn, anxious, or paranoid, with no apparent reason.
Signs and symptoms of Drug Dependence:
Drug dependence involves all the symptoms of drug abuse, but also involves another element: physical dependence.
1. Tolerance: Tolerance means that, over time, you need more drugs to feel the same effects. Do they use more drugs now than they used before? Do they use more drugs than other people without showing obvious signs of intoxication?
2. Withdrawal: As the effect of the drugs wear off, the person may experience withdrawal symptoms: anxiety or jumpiness; shakiness or trembling; sweating, nausea and vomiting; insomnia; depression; irritability; fatigue or loss of appetite and headaches. Do they use drugs to steady the nerves, stop the shakes in the morning? Drug use to relieve or avoid withdrawal symptoms is a sign of addiction.
In severe cases, withdrawal from drugs can be life-threatening and involve hallucinations, confusion, seizures, fever, and agitation. These symptoms can be dangerous and should be managed by a physician specifically trained and experienced in dealing with addiction.
3. Loss of Control: Using more drugs than they wanted to, for longer than they intended, or despite telling themselves that they wouldn’t do it this time.
4. Desire to Stop, But Can’t: They have a persistent desire to cut down or stop their drug use, but all efforts to stop and stay stopped, have been unsuccessful.
5. Neglecting Other Activities: They are spending less time on activities that used to be important to them (hanging out with family and friends, exercising or going to the gym, pursuing hobbies or other interests) because of the use of drugs.
6. Drugs Take Up Greater Time, Energy and Focus: They spend a lot of time using drugs, thinking about it, or recovering from its effects. They have few, if any, interests, social or community involvements that don’t revolve around the use of drugs.
7. Continued Use Despite Negative Consequences: They continue to use drugs even though they know it’s causing problems. As an example, person may realize that their drug use is interfering with ability to do their job, is damaging their marriage, making problems worse, or causing health problems, but they continue to use…. https://ncadd.org/learn-about-drugs/signs-and-symptoms

Remember, these are very general signs, specific drugs, narcotics, and other substances may have different signs, it is important to know the specific signs.

Kathryn Doyle of Reuters wrote in Experts caution against random drug testing in schools:

Schools should not be using random drug tests to catch or deter drug abusers, the American Academy of Pediatrics advises in an updated policy statement.

The Academy recommends against school-based “suspicionless” drug testing in the new issue of the journal Pediatrics.

Identifying kids who use drugs and entering them into treatment programs should be a top priority, but there is little evidence that random drug testing helps accomplish this, said Dr. Sharon Levy, director of the adolescent substance abuse program at Boston Children’s Hospital and lead author of the new policy statement…

Scientifically, the best way to test the value of random drug tests would be to put some kids into a drug testing program and others not, in a single school, but practically, that is difficult to accomplish. Instead, researchers have compared schools with drug testing programs to similar schools without them – and found mixed results.

One study did find a short-term reduction in kids’ self-reported drug use at a school with random testing, but the kids were followed for a relatively short period and reductions in use applied only to the drugs included in the testing. This is a problem since most drug testing panels do not include alcohol, Levy said.
“It’s possible that you do get some prevention out of these programs, but on the other hand it seems very expensive, very invasive, and has pretty limited results,” she said.

Adolescent drug use is usually sporadic, so even a kid who does use illegal substances may easily pass a random annual test and then feel comfortable to use freely for the rest of the year, she said.

Drug tests can result in false positives, and even a true positive says nothing about frequency or quantity of drug use, according to Ken C. Winters of the psychiatry department at the University of Minnesota Medical School in Minneapolis, who is not in the AAP.
http://newsdaily.com/2015/03/experts-caution-against-random-drug-testing-in-schools/#eI8U6EOrbeuGbOZZ.99

Citation:

• From the American Academy of Pediatrics
Adolescent Drug Testing Policies in Schools
1. Sharon Levy, MD, MPH, FAAP,
2. Miriam Schizer, MD, MPH, FAAP,
3. COMMITTEE ON SUBSTANCE ABUSE
Abstract
More than a decade after the US Supreme Court established the legality of school-based drug testing, these programs remain controversial, and the evidence evaluating efficacy and risks is inconclusive. The objective of this technical report is to review the relevant literature that explores the benefits, risks, and costs of these programs.

Here is the AAP statement:

AAP Opposes In School Drug Testing Due to Lack of Evidence
3/30/2015
Drug testing can be useful for pediatricians and other health care providers to assess substance use or mental health disorders in adolescents, but random drug testing in schools is a controversial approach not recommended by the American Academy of Pediatrics (AAP).

In an updated policy statement and technical report, “Adolescent Drug Testing Policies in Schools,” in the April 2015 Pediatrics (published online March 30), the AAP encourages and supports the efforts of schools to identify and address student substance abuse, but recommends against the use of school-based drug testing programs, often called suspicionless or random drug testing.

Proponents of random drug testing refer to potential advantages such as students avoiding drug use because of the negative consequences associated with having a positive drug test results, while opponents of random drug testing agree that the disadvantages are much greater, and can include deterioration in the student-school relationship, confidentiality of students’ medical records, and mistakes in interpreting drug tests that can result in false-positive results.

The AAP recommends against the use of school-based drug testing programs because of limited evidence of efficacy and potential risks associated with this procedure. Pediatricians support the development of effective substance abuse services in schools, along with appropriate referral policies in place for adolescents struggling with substance abuse disorders.
# # #

The American Academy of Pediatrics is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.
https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Opposes-In-school-Drug-Testing-Due-to-Lack-of-Evidence.aspx

The National Institute on Drug Abuse (Institute) has some great information about drug testing. In Frequently Asked Questions About Drug Testing in Schools, the Institute discusses drug testing.

Why test teenagers at all?

Teens are especially vulnerable to drug abuse, when the brain and body are still developing. Most teens do not use drugs, but for those who do, it can lead to a wide range of adverse effects on the brain, the body, behavior and health.
Short term: Even a single use of an intoxicating drug can affect a person’s judgment and decisonmaking—resulting in accidents, poor performance in a school or sports activity, unplanned risky behavior, and the risk of overdosing.
Long term: Repeated drug abuse can lead to serious problems, such as poor academic outcomes, mood changes (depending on the drug: depression, anxiety, paranoia, psychosis), and social or family problems caused or worsened by drugs.
Repeated drug use can also lead to the disease of addiction. Studies show that the earlier a teen begins using drugs, the more likely he or she will develop a substance abuse problem or addiction. Conversely, if teens stay away from drugs while in high school, they are less likely to develop a substance abuse problem later in life….
Is random drug testing of students legal?
In June 2002, the U.S. Supreme Court broadened the authority of public schools to test students for illegal drugs. Voting 5 to 4 in Pottawatomie County v. Earls, the court ruled to allow random drug tests for all middle and high school students participating in competitive extracurricular activities. The ruling greatly expanded the scope of school drug testing, which previously had been allowed only for student athletes.
Just because the U.S. Supreme Court said student drug testing for adolescents in competitive extracurricular activities is constitutional, does that mean it is legal in my city or state?
A school or school district that is interested in adopting a student drug testing program should seek legal expertise so that it complies with all federal, state, and local laws. Individual state constitutions may dictate different legal thresholds for allowing student drug testing. Communities interested in starting student drug testing programs should become familiar with the law in their respective states to ensure proper compliance. http://www.drugabuse.gov/related-topics/drug-testing/faq-drug-testing-in-schools

The primary issue is whether students have privacy rights.

Your Debate.com summarizes the pros and cons of School Drug Testing:

PRO 1
The main purpose of random school drug testing is not to catch kids using drugs, it to keep them from ever using them. Once their using drugs its harder for them to break their addiction. With many employers drug testing its very important for a kid’s future not to use drugs. Drug use is responsible for many crimes. Its worth the inconvenience for all our future.
CON 2
One of the fundamental features of our legal system is that we are presumed innocent of any wrongdoing unless and until the government proves otherwise. Random drug testing of student athletes turns this presumption on its head, telling students that we assume they are using drugs until they prove to the contrary with a urine sample.
CON 3
“If school officials have reason to believe that a particular student is using drugs, they already have the power to require that student to submit to a drug test,” said ACLU-NJ Staff Attorney David Rocah.
CON 4
The constitutional prohibition against “unreasonable” searches also embodies the principle that merely belonging to a certain group is not a sufficient reason for a search, even if many members of that group are suspected of illegal activity. Thus, for example, even if it were true that most men with long hair were drug users, the police would not be free to stop all long haired men and search them for drugs.
PRO 5
Peer pressure is the greatest cause of kids trying drugs. If by testing the athletes or other school leaders, we can get them to say no to drugs, it will be easier for other kids to say no.
CON 6
Some also argue that students who aren’t doing anything wrong have nothing to fear. This ignores the fact that what they fear is not getting caught, but the loss of dignity and trust that the drug test represents. And we should all be afraid of government officials who believe that a righteous cause warrants setting aside bedrock constitutional protections. The lesson that our schools should be teaching is respect for the Constitution and for students’ dignity and privacy, not a willingness to treat cherished constitutional principles as mere platitudes. http://www.youdebate.com/DEBATES/school_drug_testing.HTM

See, What Are the Benefits of Drug Testing?http://www.livestrong.com/article/179407-what-are-the-benefits-of-drug-testing/

Substance abuse is often a manifestation of other problems that child has either at home or poor social relations including low self-esteem.

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

Al-Anon and Alateen

http://al-anon.alateen.org/

National Clearinghouse for Drug and Alcohol Information

http://www.samhsa.gov/

The U.S. Department of Health and Human Services has a very good booklet for families What is Substance Abuse Treatment?

http://www.samhsa.gov/kap

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/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

Australian study: Frequent marijuana use among those under 17 may result in lower educational achievement

23 Sep

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

Simon Makin reported in the Scientific American article, Does Marijuana Harm the Brain?

The Claim
Casual cannabis use harms young people’s brains.
The Facts
A study found differences in the brains of users and nonusers, but it did not establish that marijuana use caused the variations or that they had any functional significance.
The Details
Researchers at Northwestern University and Harvard Medical School conducted MRI scans of two groups of 20 young adults ages 18 to 25. One group reported using marijuana at least once a week, smoking 11 joints a week on average, whereas the other had used it less than five times total and not at all during the last year. Neither group had any psychiatric disorders, and the users were psychiatrically assessed as not dependent on the drug.
The study focused on two brain regions involved in processing rewards, the nucleus accumbens and the amygdala. These areas create pleasurable experiences of things such as food and sex, as well as the high associated with drugs, and have been shown to change in animals given THC, the main psychoactive component of cannabis.
The researchers found that cannabis users had more gray matter density in the left nucleus accumbens and left amygdala, as well as differences in the shape of the left nucleus accumbens and right amygdala. The left nucleus accumbens also tended to be slightly larger in users. They concluded that recreational cannabis use might be associated with abnormalities in the brain’s reward system. News reports have proclaimed that scientists have shown that even casual cannabis use harms young people’s brains.
The Caveats
The most obvious problem with leaping to that conclusion is that the scans were conducted at only one point. This approach can compare the two groups, but it cannot prove cannabis caused any differences between them—or even that the differences represent changes over time. They could be preexisting variations, or cannabis use and brain changes may both be related to a third factor, such as tobacco (although the study did attempt to take levels of smoking into account)…..
Reality Check—Cannabis use has been found to:
• Cause dependence, at some point in their lives, in about 9 percent of people who try it.
• Impair various aspects of cognitive function, particularly memory. Impairments can remain for several days. One study showed that performance returns to nonusers’ levels after 28 days of abstinence, but evidence is mixed about how long the impairments last.
• Potentially reduce the volume of the hippocampus, which is critical for memory—but only after heavy and prolonged use. The evidence linking cognitive impairments to specific brain changes is inconclusive, and the degree to which such changes are reversible is hotly debated. http://www.scientificamerican.com/article/does-marijuana-harm-the-brain/

Science Daily reported a longitudinal study from Australia and New Zealand.

In Frequent cannabis use in adolescence linked with reduced educational attainment, other problems in young adults, Science Daily reported:

Individuals who are daily users of cannabis before age 17 are over 60% less likely to complete high school or obtain a degree compared to those who have never used the drug, new research published in The Lancet Psychiatry journal shows. The large meta-analysis also indicates that daily users of cannabis during adolescence are seven times more likely to attempt suicide, have an 18 times greater chance of cannabis dependence, and are eight times as likely to use other illicit drugs in later life.
“Our findings are particularly timely given that several US states and countries in Latin America have made moves to decriminalize or legalize cannabis, raising the possibility that the drug might become more accessible to young people”, says Richard Mattick, study author and Professor of Drug and Alcohol Studies at the National Drug and Alcohol Research Centre, University of New South Wales, in Australia.
Cannabis is the most widely used illicit drug globally and recent statistics have shown that in some countries adolescents are starting cannabis use at a younger age and more adolescents are using cannabis heavily. In England, 4% of 11-15 year olds report cannabis use in the past month, roughly 7% of US high-school seniors are daily or near-daily cannabis users, and in Australia, around 1% of 14-19 year olds are daily users of the drug, whilst 4% use weekly.
In this study, a team of Australian and New Zealand researchers combined individual-level data on up to 3765 participants who used cannabis from three large, long-running longitudinal studies to find out more about the link between the frequency of cannabis use before the age of 17 years (never, less than monthly, monthly or more, weekly or more, or daily) and seven developmental outcomes up to the age of 30 years (completing high school, obtaining a university degree, cannabis dependence, use of other illicit drugs, suicide attempt, depression, and welfare dependence)….
http://www.sciencedaily.com/releases/2014/09/140909192001.htm

Citation:

Frequent cannabis use in adolescence linked with reduced educational attainment, other problems in young adults
Date: September 9, 2014

Source: The Lancet
Summary:
Individuals who are daily users of cannabis before age 17 are over 60% less likely to complete high school or obtain a degree compared to those who have never used the drug, new research shows. The large meta-analysis also indicates that daily users of cannabis during adolescence are seven times more likely to attempt suicide, have an 18 times greater chance of cannabis dependence, and are eight times as likely to use other illicit drugs in later life.

Copyright © 2014 Elsevier Ltd All rights reserved.
Young adult sequelae of adolescent cannabis use: an integrative analysis
Dr Edmund Silins PhD a Corresponding AuthorEmail Address, L John Horwood MSc c, Prof George C Patton MD d g, Prof David M Fergusson PhD c, Craig A Olsson PhD d e g h, Delyse M Hutchinson PhD a, Elizabeth Spry BA d, Prof John W Toumbourou PhD d e, Prof Louisa Degenhardt PhD a d f i, Wendy Swift PhD a, Carolyn Coffey PhD d, Robert J Tait PhD j k, Primrose Letcher PhD g, Prof Jan Copeland PhD b, Richard P Mattick PhD a, for the Cannabis Cohorts Research Consortium†

Summary

Background

Debate continues about the consequences of adolescent cannabis use. Existing data are limited in statistical power to examine rarer outcomes and less common, heavier patterns of cannabis use than those already investigated; furthermore, evidence has a piecemeal approach to reporting of young adult sequelae. We aimed to provide a broad picture of the psychosocial sequelae of adolescent cannabis use.
Methods

We integrated participant-level data from three large, long-running longitudinal studies from Australia and New Zealand: the Australian Temperament Project, the Christchurch Health and Development Study, and the Victorian Adolescent Health Cohort Study. We investigated the association between the maximum frequency of cannabis use before age 17 years (never, less than monthly, monthly or more, weekly or more, or daily) and seven developmental outcomes assessed up to age 30 years (high-school completion, attainment of university degree, cannabis dependence, use of other illicit drugs, suicide attempt, depression, and welfare dependence). The number of participants varied by outcome (N=2537 to N=3765).

Findings

We recorded clear and consistent associations and dose-response relations between the frequency of adolescent cannabis use and all adverse young adult outcomes. After covariate adjustment, compared with individuals who had never used cannabis, those who were daily users before age 17 years had clear reductions in the odds of high-school completion (adjusted odds ratio 0•37, 95% CI 0•20—0•66) and degree attainment (0•38, 0•22—0•66), and substantially increased odds of later cannabis dependence (17•95, 9•44—34•12), use of other illicit drugs (7•80, 4•46—13•63), and suicide attempt (6•83, 2•04—22•90).

Interpretation

Adverse sequelae of adolescent cannabis use are wide ranging and extend into young adulthood. Prevention or delay of cannabis use in adolescence is likely to have broad health and social benefits. Efforts to reform cannabis legislation should be carefully assessed to ensure they reduce adolescent cannabis use and prevent potentially adverse developmental effects.

Funding

Australian Government National Health and Medical Research Council.
Young adult sequelae of adolescent cannabis use: an integrative analysis : The Lancet Psychiatry National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW, Australia
Young adult sequelae of adolescent cannabis use: an integrative analysis : The Lancet Psychiatry
Young adult sequelae of adolescent cannabis use: an integrative analysis. By – Dr Edmund Silins PhD, L John Horwood MSc, Prof George C Patton MD, Prof David M Fergusson PhD, Craig A Olsson PhD, Del…
View on http://www.thelancet.com
b National Cannabis Prevention and Information Centre, UNSW Australia, Sydney, NSW, Australia
c Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
d Centre for Adolescent Health, Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, VIC, Australia
e School of Psychology, Deakin University, Geelong, VIC, Australia
f School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
g Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
h Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
i Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
j National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
k Centre for Research on Ageing Health and Wellbeing, Australian National University, Canberra, ACT, Australia
Corresponding Author Information Correspondence to: Dr Edmund Silins, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW 2052, Australia
† Other members listed at end of paper

What Steps Should a Parent Take?

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/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

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University of Pennsylvania Annenberg Public Policy Center study: Drug testing high school students might not be effective

14 Jan

Moi wrote in Missouri high school to drug test students:
Fox News reported in the story, Missouri high school reportedly to use hair samples for random drug tests:
Beginning in the 2013-2014 school year, students at Rockhurst High School in Kansas City will be mandated to undergo random drug testing by submitting roughly 60 strands of hair to a staff member at the 1,000-student school, KSHB.com reports….
If a student tests positive for any substance, according to the new policy, a guidance counselor will be notified. The counselor will then notify the student’s parents to determine how to best help the child.
The student would then be given 90 days to be drug-free, with no notification sent to administrative personnel. The incident would only be noted in the student’s guidance file, which would later be destroyed upon graduation and will not be sent to colleges or universities. The document would only become public if subpoenaed, the website reports. http://www.foxnews.com/us/2013/01/31/missouri-high-school-reportedly-to-use-hair-samples-for-random-drug-tests/#ixzz2KXRqmSpX
The National Institute on Drug Abuse (Institute) has some great information about drug testing.
In Frequently Asked Questions About Drug Testing in Schools, the Institute discusses drug testing.
Why test teenagers at all?
Teens are especially vulnerable to drug abuse, when the brain and body are still developing. Most teens do not use drugs, but for those who do, it can lead to a wide range of adverse effects on the brain, the body, behavior and health.
Short term: Even a single use of an intoxicating drug can affect a person’s judgment and decisonmaking—resulting in accidents, poor performance in a school or sports activity, unplanned risky behavior, and the risk of overdosing.
Long term: Repeated drug abuse can lead to serious problems, such as poor academic outcomes, mood changes (depending on the drug: depression, anxiety, paranoia, psychosis), and social or family problems caused or worsened by drugs.
Repeated drug use can also lead to the disease of addiction. Studies show that the earlier a teen begins using drugs, the more likely he or she will develop a substance abuse problem or addiction. Conversely, if teens stay away from drugs while in high school, they are less likely to develop a substance abuse problem later in life….
Is random drug testing of students legal?
In June 2002, the U.S. Supreme Court broadened the authority of public schools to test students for illegal drugs. Voting 5 to 4 in Pottawatomie County v. Earls, the court ruled to allow random drug tests for all middle and high school students participating in competitive extracurricular activities. The ruling greatly expanded the scope of school drug testing, which previously had been allowed only for student athletes.
Just because the U.S. Supreme Court said student drug testing for adolescents in competitive extracurricular activities is constitutional, does that mean it is legal in my city or state?
A school or school district that is interested in adopting a student drug testing program should seek legal expertise so that it complies with all federal, state, and local laws. Individual state constitutions may dictate different legal thresholds for allowing student drug testing. Communities interested in starting student drug testing programs should become familiar with the law in their respective states to ensure proper compliance. http://www.drugabuse.gov/related-topics/drug-testing/faq-drug-testing-in-schools
The primary issue is whether students have privacy rights.
Your Debate.com summarizes the pros and cons of School Drug Testing:
PRO 1
The main purpose of random school drug testing is not to catch kids using drugs, it to keep them from ever using them. Once their using drugs its harder for them to break their addiction. With many employers drug testing its very important for a kid’s future not to use drugs. Drug use is responsible for many crimes. Its worth the inconvenience for all our future.
CON 2
One of the fundamental features of our legal system is that we are presumed innocent of any wrongdoing unless and until the government proves otherwise. Random drug testing of student athletes turns this presumption on its head, telling students that we assume they are using drugs until they prove to the contrary with a urine sample.
CON 3
“If school officials have reason to believe that a particular student is using drugs, they already have the power to require that student to submit to a drug test,” said ACLU-NJ Staff Attorney David Rocah.
CON 4
The constitutional prohibition against “unreasonable” searches also embodies the principle that merely belonging to a certain group is not a sufficient reason for a search, even if many members of that group are suspected of illegal activity. Thus, for example, even if it were true that most men with long hair were drug users, the police would not be free to stop all long haired men and search them for drugs.
PRO 5
Peer pressure is the greatest cause of kids trying drugs. If by testing the athletes or other school leaders, we can get them to say no to drugs, it will be easier for other kids to say no.
CON 6
Some also argue that students who aren’t doing anything wrong have nothing to fear. This ignores the fact that what they fear is not getting caught, but the loss of dignity and trust that the drug test represents. And we should all be afraid of government officials who believe that a righteous cause warrants setting aside bedrock constitutional protections. The lesson that our schools should be teaching is respect for the Constitution and for students’ dignity and privacy, not a willingness to treat cherished constitutional principles as mere platitudes. http://www.youdebate.com/DEBATES/school_drug_testing.HTM
See, What Are the Benefits of Drug Testing? http://www.livestrong.com/article/179407-what-are-the-benefits-of-drug-testing/ https://drwilda.com/2013/02/11/missouri-high-school-to-drug-test-students/
Maanvi Singh of NPR reported in the study, Drug Tests Don’t Deter Drug Use, But School Environment Might:
Schools that do random drug testing say it helps students say no to illegal drugs, while critics say it’s an invasion of privacy. But feeling good about school may affect students’ drug use more than the threat of testing.
A survey of high school students found that the possibility that they might face drug testing didn’t really discourage students from alcohol, cigarettes or marijuana. But students who thought their school had a positive environment were less apt to try cigarettes and pot.
Those students were about 20 percent less likely to try smoke pot and 15 percent less likely to light up a cigarette than students who didn’t feel that their school was a positive place, the survey found. And the trend held true, more or less, regardless of demographic or geographic factors.
Researchers from the University of Pennsylvania’s Annenberg Public Policy Center looked at 361 high school students across the country. The students were initially interviewed in 2008 as part of the more general National Annenberg Survey of Youth. A year later, researchers followed up and asked participants whether they had tried alcohol, or smoked cigarettes or marijuana.
The research was published Monday in the Journal of Studies on Alcohol and Drugs. Dan Romer, an author of the study who directs Annenberg’s Adolescent Communication Institute, says he wasn’t surprised by the results. “In a school with a good climate, the kids will respect what the teachers say more,” he tells Shots.
The key, Romer says, is that students need to understand why a school has certain disciplinary policies. “It basically boils down to how much respect everybody feels toward each other,” he says.
Proponents of random drug testing say it can act as a deterrent, or as a way to identify students in need of help. The Supreme Court has upheld the constitutionality of the practice twice, in 1995 and 2002. But the court limited its use to students participating in competitive extracurricular activities.
A school that has a positive climate might also practice drug testing, Romer said – the two aren’t mutually exclusive. But this study suggests that administrators concerned about substance abuse might want to try programs that encourage a more respectful school climate before turning to drug testing.
This study is by no means conclusive. It doesn’t distinguish between schools that implement randomized drug testing and those that only test students suspected of drug use. And it doesn’t look at whether other drug education programs might have influenced the results.
These findings reinforce previous research that casts doubt on the effectiveness of drug testing as a deterrent. A 2010 study from the University of Michigan found that in schools with drug testing, students were more likely to turn from marijuana to other illicit drugs.
One thing that neither a drug policy nor a positive environment seemed to affect was underage drinking. “It suggests to us that alcohol may be so accepted now in high school culture,” Romer says, “that kids think if you’re at a party you should be able to drink.” http://www.npr.org/blogs/health/2014/01/14/262466903/drug-tests-dont-deter-drug-use-but-school-environment-might?utm_medium=Email&utm_source=share&utm_campaign=
See, School drug tests don’t work, but ‘positive climate’ might http://www.health.am/psy/more/school-drug-tests-dont-work/#ixzz2qQ58LUDr
Here is the press release from University of Pennsylvania’s Annenberg Public Policy Center:
School drug tests ineffective but a ‘positive climate’ might work
Monday, January 13th, 2014
A national study of teenagers suggests that school drug testing did not deter them from starting to smoke tobacco or marijuana or drink alcohol. But in high schools that had a “positive school climate,” teens were less likely to start smoke cigarettes or marijuana.
Research published in the January issue of the Journal of Studies on Alcohol and Drugs compared the effectiveness over one year of school policies of student drug testing, which are in place in an estimated 20 percent of U.S. high schools, with a positive school climate.
“The bad news is that a policy of drug testing has no effect on students starting to use alcohol, cigarettes or marijuana,” said study co-author Dan Romer, associate director of the Annenberg Public Policy Center (APPC) at the University of Pennsylvania. “There’s also no effect on escalating the use of those substances.”
The study found, however, that students in schools with a positive school climate reported a lower rate of starting to use cigarettes and marijuana, and a slower escalation of smoking at the one-year follow-up interview. Students in schools with positive climates were 15 percent less likely to start smoking cigarettes and 20 percent less likely to start using marijuana than students at schools without positive climates, the study shows.
Student drug testing “is a relatively ineffective drug-prevention policy,” wrote the researchers, Dan Romer and Sharon R. Sznitman, an APPC Distinguished Research Fellow and a lecturer at the School of Public Health, University of Haifa, Israel. “On the other hand, interventions that improve school climate may have greater efficacy.” The study added that “whole school” health efforts that engage students, faculty and parents, and promote a sense of security and well-being have been found to reduce substance abuse.
Neither drug testing nor school climate affected the start of drinking alcohol.
For the complete news release click here. http://www.annenbergpublicpolicycenter.org/wp-content/uploads/Student-drug-tests-01-13-14.pdf
To read the study click here. http://www.jsad.com/jsad/article/Student_Drug_Testing_and_Positive_School_Climates_Testing_the_Relation_Bet/4893.html
And for APPC’s issue brief on student drug testing, click here. http://www.annenbergpublicpolicycenter.org/issue-brief-drug-prevention-in-schools/
Citation:
Journal of Studies on Alcohol and Drugs
Volume 75, 2014 > Issue 1: January 2014
Download PDF Document
http://www.jsad.com/jsad/downloadarticle/Student_Drug_Testing_and_Positive_School_Climates_Testing_the_Relation_Bet/5232.pdf
Student Drug Testing and Positive School Climates: Testing the Relation Between Two School Characteristics and Drug Use Behavior in a Longitudinal Study [OPEN ACCESS]
Sharon R. Sznitman, Daniel Romer
Objective: Fostering positive school climates and student drug testing have been separately proposed as strategies to reduce student drug use in high schools. To assess the promise of these strategies, the present research examined whether positive school climates and/or student drug testing successfully predicted changes in youth substance use over a 1-year follow-up. Method: Two waves of panel data from a sample of 361 high school students, assessed 1 year apart, were analyzed. Changes in reported initiation and escalation in frequency of alcohol, cigarette, and marijuana use as a function of perceived student drug testing and positive school climates were analyzed, while we held constant prior substance use. Results: Perceived student drug testing was not associated with changes in substance use, whereas perceived positive school climates were associated with a reduction in cigarette and marijuana initiation and a reduction in escalation of frequency of cigarette use at 1-year follow-up. However, perceived positive school climates were not associated with a reduction in alcohol use. Conclusions: Student drug testing appears to be less associated with substance use than positive school climates. Nevertheless, even favorable school climates may not be able to influence the use of alcohol, which appears to be quite normative in this age group. (J. Stud. Alcohol Drugs, 75, 65–73, 2014)
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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 increase https://drwilda.com/2013/10/13/university-of-washington-study-heroin-use-among-young-suburban-and-rural-non-traditional-users-on-the-increase/
Northwestern University study: Young adolescent use of marijuana results in changes to the brain structure https://drwilda.com/2013/12/23/northwestern-university-study-young-adolescent-use-of-marijuana-results-in-changes-to-the-brain-structure/
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/
Where information leads to Hope. © Dr. Wilda.com
Dr. Wilda says this about that ©
Blogs by Dr. Wilda:
COMMENTS FROM AN OLD FART© http://drwildaoldfart.wordpress.com/
Dr. Wilda Reviews © http://drwildareviews.wordpress.com/
Dr. Wilda © https://drwilda.com/

Northwestern University study: Young adolescent use of marijuana results in changes to the brain structure

23 Dec

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

Anahad O’Connor reported in the New York Times article, Increasing Marijuana Use in High School Is Reported:

A new federal report shows that the percentage of American high school students who smoke marijuana is slowly rising, while the use of alcohol and almost every other drug is falling.
The report raises concerns that the relaxation of restrictions on marijuana, which can now be sold legally in 20 states and the District of Columbia, has been influencing use of the drug among teenagers. Health officials are concerned by the steady increase and point to what they say is a growing body of evidence that adolescent brains, which are still developing, are susceptible to subtle changes caused by marijuana.
“The acceptance of medical marijuana in multiple states leads to the sense that if it’s used for medicinal purposes, then it can’t be harmful,” said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, which issued the report. “This survey has shown very consistently that the greater the number of kids that perceive marijuana as risky, the less that smoke it.” Starting early next year, recreational marijuana use will also be legal in Colorado and Washington.
Experts debate the extent to which heavy marijuana use may cause lasting detriment to the brain. But Dr. Volkow said that one way marijuana might affect cognitive function in adolescents was by disrupting the normal development of white matter through which cells in the brain communicate.
According to the latest federal figures, which were part of an annual survey, Monitoring the Future, more than 12 percent of eighth graders and 36 percent of seniors at public and private schools around the country said they had smoked marijuana in the past year. About 60 percent of high school seniors said they did not view regular marijuana use as harmful, up from about 55 percent last year.
The report looked at a wide variety of drugs and substances. It found, for example, that drinking was steadily declining, with roughly 40 percent of high school seniors reporting having used alcohol in the past month, down from a peak of 53 percent in 1997. Abuse of the prescription painkiller Vicodin is half what it was a decade ago among seniors; cocaine and heroin use are at historic lows in almost every grade.
Cigarette smoking has also fallen precipitously in recent years. For the first time since the survey began, the percentage of students who smoked a cigarette in the past month dropped below 10 percent. Roughly 8.5 percent of seniors smoke cigarettes on a daily basis, compared with 6.5 percent who smoke marijuana daily, a slight increase from 2010.
Studies show that the concentration of THC in marijuana, its psychoactive ingredient, has tripled since the early 1990s, and Dr. Volkow said there was concern that the rising use and increased potency could affect the likelihood of car accidents and could lower school performance.
“What is most worrisome is that we’re seeing high levels of everyday use of marijuana among teenagers,” Dr. Volkow said. “That is the type that’s most likely to have negative effects on brain function and performance.”
http://well.blogs.nytimes.com/2013/12/18/growing-marijuana-use-among-teenagers-spurs-concerns/?_r=1
Northwestern University researchers studied the effect of early marijuana use on adolescent brains.

Citation:

Cannabis-Related Working Memory Deficits and Associated Subcortical Morphological Differences in Healthy Individuals and Schizophrenia Subjects
Matthew J. Smith*,1,
Derin J. Cobia1,
Lei Wang1,2,
Kathryn I. Alpert1,
Will J. Cronenwett1,
Morris B. Goldman1,
Daniel Mamah3,
Deanna M. Barch3–5,7,
Hans C. Breiter1,6,7 and
John G. Csernansky1,7
+
Author Affiliations
1 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL;
2 Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL;
3 Department of Psychiatry, Washington University, St Louis, MO;
4 Department of Psychology, Washington University, St Louis, MO;
5 Department of Radiology, Washington University, St Louis, MO;
6 Warren Wright Adolescent Center, Northwestern University Feinberg School of Medicine, Chicago, IL
7Denotes shared senior authorship on this article.
↵*To whom correspondence should be addressed; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, 13th Floor, Abbott Hall, Chicago, IL 60611, US; tel: 1-312-503-2542, fax: 1-312-503-0527, e-mail: matthewsmith@northwestern.edu
Abstract
Cannabis use is associated with working memory (WM) impairments; however, the relationship between cannabis use and WM neural circuitry is unclear. We examined whether a cannabis use disorder (CUD) was associated with differences in brain morphology between control subjects with and without a CUD and between schizophrenia subjects with and without a CUD, and whether these differences related to WM and CUD history. Subjects group-matched on demographics included 44 healthy controls, 10 subjects with a CUD history, 28 schizophrenia subjects with no history of substance use disorders, and 15 schizophrenia subjects with a CUD history. Large-deformation high-dimensional brain mapping with magnetic resonance imaging was used to obtain surface-based representations of the striatum, globus pallidus, and thalamus, compared across groups, and correlated with WM and CUD history. Surface maps were generated to visualize morphological differences. There were significant cannabis-related parametric decreases in WM across groups. Similar cannabis-related shape differences were observed in the striatum, globus pallidus, and thalamus in controls and schizophrenia subjects. Cannabis-related striatal and thalamic shape differences correlated with poorer WM and younger age of CUD onset in both groups. Schizophrenia subjects demonstrated cannabis-related neuroanatomical differences that were consistent and exaggerated compared with cannabis-related differences found in controls. The cross-sectional results suggest that both CUD groups were characterized by WM deficits and subcortical neuroanatomical differences. Future longitudinal studies could help determine whether cannabis use contributes to these observed shape differences or whether they are biomarkers of a vulnerability to the effects of cannabis that predate its misuse.
http://schizophreniabulletin.oxfordjournals.org/content/early/2013/12/10/schbul.sbt176.abstract

Here is the press release from Northwestern University:

Marijuana Users Have Abnormal Brain Structure and Poor Memory
Drug abuse appears to foster brain changes that resemble schizophrenia
December 16, 2013 | by Marla Paul
• The younger drug abuse starts, the more abnormal the brain
CHICAGO — Teens who were heavy marijuana users — smoking it daily for about three years — had abnormal changes in their brain structures related to working memory and performed poorly on memory tasks, reports a new Northwestern Medicine® study.
A poor working memory predicts poor academic performance and everyday functioning.
The brain abnormalities and memory problems were observed during the individuals’ early twenties, two years after they stopped smoking marijuana, which could indicate the long-term effects of chronic use. Memory-related structures in their brains appeared to shrink and collapse inward, possibly reflecting a decrease in neurons.
The study also shows the marijuana-related brain abnormalities are correlated with a poor working memory performance and look similar to schizophrenia-related brain abnormalities. Over the past decade, Northwestern scientists, along with scientists at other institutions, have shown that changes in brain structure may lead to changes in the way the brain functions.
This is the first study to target key brain regions in the deep subcortical gray matter of chronic marijuana users with structural MRI and to correlate abnormalities in these regions with an impaired working memory. Working memory is the ability to remember and process information in the moment and — if needed — transfer it to long-term memory. Previous studies have evaluated the effects of marijuana on the cortex, and few have directly compared chronic marijuana use in otherwise healthy individuals and individuals with schizophrenia.
The younger the individuals were when they started chronically using marijuana, the more abnormally their brain regions were shaped, the study reports. The findings suggest that these regions related to memory may be more susceptible to the effects of the drug if abuse starts at an earlier age.
“The study links the chronic use of marijuana to these concerning brain abnormalities that appear to last for at least a few years after people stop using it,” said lead study author Matthew Smith, an assistant research professor in psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. “With the movement to decriminalize marijuana, we need more research to understand its effect on the brain.”
The paper was published Dec. 16 in the journal Schizophrenia Bulletin.
In the U.S., marijuana is the most commonly used illicit drug and young adults have the highest — and growing — prevalence of use. Decriminalization of the drug may lead to greater use.
Because the study results examined one point in time, a longitudinal study is needed to definitively show if marijuana is responsible for the brain changes and memory impairment. It is possible that the abnormal brain structures reveal a pre-existing vulnerability to marijuana abuse. But evidence that the younger a subject started using the drug the greater his brain abnormality indicates marijuana may be the cause, Smith said.
The groups in the study started using marijuana daily between 16 to 17 years of age for about three years. At the time of the study, they had been marijuana free for about two years. A total of 97 subjects participated, including matched groups of healthy controls, subjects with a marijuana use disorder, schizophrenia subjects with no history of substance use disorders, and schizophrenia subjects with a marijuana use disorder. The subjects who used marijuana did not abuse any other drugs.
Few studies have examined marijuana’s effect on the deep regions in the brain — the ‘subcortical gray matter’ below the noodle-shaped cortex. The study also is unique in that it looked at the shapes of the striatum, globus pallidus and thalamus, structures in the subcortex that are critical for motivation and working memory.
The Marijuana and Schizophrenia Connection
Chronic use of marijuana may contribute to changes in brain structure that are associated with having schizophrenia, the Northwestern research shows. Of the 15 marijuana smokers who had schizophrenia in the study, 90 percent started heavily using the drug before they developed the mental disorder. Marijuana abuse has been linked to developing schizophrenia in prior research.
“The abuse of popular street drugs, such as marijuana, may have dangerous implications for young people who are developing or have developed mental disorders,” said co-senior study author John Csernansky, M.D., chair of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital. “This paper is among the first to reveal that the use of marijuana may contribute to the changes in brain structure that have been associated with having schizophrenia.”
Chronic marijuana use could augment the underlying disease process associated with schizophrenia, Smith noted. “If someone has a family history of schizophrenia, they are increasing their risk of developing schizophrenia if they abuse marijuana,” he said.
While chronic marijuana smokers and chronic marijuana smokers with schizophrenia both had brain changes related to the drug, subjects with the mental disorder had greater deterioration in the thalamus. That structure is the communication hub of the brain and is critical for learning, memory and communications between brain regions. The brain regions examined in this study also affect motivation, which is already notably impaired in people with schizophrenia.
“A tremendous amount of addiction research has focused on brain regions traditionally connected with reward/aversion function, and thus motivation,” noted co-senior study author Hans Breiter, M.D., professor of psychiatry and behavioral sciences and director of the Warren Wright Adolescent Center at Feinberg and Northwestern Memorial. “This study very nicely extends the set of regions of concern to include those involved with working memory and higher level cognitive functions necessary for how well you organize your life and can work in society.”
“If you have schizophrenia and you frequently smoke marijuana, you may be at an increased risk for poor working memory, which predicts your everyday functioning,” Smith said.
The research was supported by grants R01 MH056584 and P50 MH071616 from the National Institute of Mental Health and grants P20 DA026002 and RO1 DA027804 from National Institute of Drug Abuse, all of the National Institutes of Health.
– See more at: http://www.northwestern.edu/newscenter/stories/2013/12/marijuana-users-have-abnormal-brain-structure–poor-memory.html#sthash.coRZr6cm.dpuf

What Steps Should a Parent Take?

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.

Questions to Ask a Treatment Facility

The U.S. Department of Health and Human Services, Center for Substance Abuse Treatment (Center), lists the questions that should be asked of a treatment center. http://findtreatment.samhsa.gov/faq.htm Assuming you are not one of those ill-advised parents who supply their child with alcohol or drugs like marijuana in an attempt to be hip or cool, suspicions that your child may have a substance abuse problem are a concern. Confirmation that your child has a substance abuse problem can be heartbreaking. Even children whose parents have seemingly done everything right can become involved with drugs. The best defense is knowledge about your child, your child’s friends, and your child’s activities

Related:

University of Washington study: Heroin use among young suburban and rural non-traditional users on the increase 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/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/