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Most of World Lacks Access to Pain Drugs, UN Agency Says [FEATURE]

More than eight out of 10 of the world's inhabitants have little or no access to opioid pain medications, the International Narcotics Control Board (INCB) said Wednesday. The finding came as the INCB released both its Annual Report 2010 and a special report on the global availability of pain medications.

INCB head Hamid Ghodse (l) briefing reporters in Vienna (incb.org)
People in many countries in Africa, Asia, and parts of the Americas had little or no access to opioid pain medications and psychotropic substances for medical purposes, the INCB found. Opioids include both narcotics, such as morphine and oxycodone, and synthetic opiates, such as fentanyl. Psychotropic medicines include depressants, antidepressants, and antipsychotics.

"Ninety percent of the licit drugs are consumed by 10% of the world's population in the United States, Australia, Canada, New Zealand and some European countries," Hamid Ghodse, the INCB's president, said in a briefing on the release of the reports. "It has to be recognized that the availability of narcotics and psychotropic medicines is indispensable to medical practice," Ghodse told reporters.

The US is by far the world's leading consumer of opioid pain medications. According to INCB figures, for every pain pill consumed per capita in Asia, Africa, or Latin America, 50 are consumed in Europe, and 300 in North America. The US alone, with 5% of the world population, consumed 56% of the world's pain pills. [Editor's Note: This does not mean that US patients who need opioids can always get prescriptions for them.]

The special report on the availability of pain medicines found that while the global supply of raw opium for licit needs is adequate, there are a number of obstacles blocking their availability in large parts of the world. The INCB identified the obstacles in descending order as concerns about addiction, reluctance to stock or prescribe, lack of training of professionals, restrictive laws, administrative problems, cost, distribution problems, lack of supply, and absence of policies around the prescribing of the drugs for pain treatment.

Lack of supply was near the bottom of the list. The INCB said opiate raw materials, including opium, poppy straw, and poppy straw concentrate were sufficient to outstrip consumption. "There is no problem whatsoever with the availability of raw materials," Ghodse said.

Ghodse called on governments to analyze the problem, identify barriers to adequate availability, and take action to reduce or remove them. The report called on governments to collect data on licit drug requirements, legislation, education and training, national drug control systems, and steps to combat misuse.

For the INCB, the flip side of barriers to adequate pain pill access in large swathes of the world is excess availability, which it said can lead to abuse and drug dependence. While the number of single doses of opioid pain medications consumed has increased four-fold in the last 20 years, driven largely by increases in synthetic opioid production, consumption in the US, for example, has increased six-fold. The US now sees more people dying of prescription drug overdoses than from illegal drugs.

morphine consumption by region (incb.org)
"In countries with excessive availability, the non-medical use of pain relievers, tranquillizers, stimulants or sedatives has become the fastest growing drug problem," the report said.

That is a theme repeated from last year's INCB report, when the monitoring body reported that the abuse of prescription drugs was increasingly markedly worldwide. More people were taking prescription drugs for non-medical reasons than were using heroin, cocaine, and ecstasy combined, that report said.

Another major theme for the INCB in this year's report was increasing concern over the emergence of new synthetic drugs, or what it called designer drugs. The INCB said the development of such drugs is escalating so rapidly that governments need to adopt generic bans on new substances.

The report cited 4-methyl-methcathinone, or mephedrone, which has effects similar to cocaine or amphetamines and is being marketed as bath salts under names like Ivory Wave. The drug is currently the cause of ongoing concern in the US, where it has been banned in at least four states, and in Europe, where it has been banned by the European Union.

"Mephedrone has now become a problem drug of abuse in Europe, North America, Southeast Asia and in Australia and New Zealand," the INCB report said. But mephedrone is just "one example of a large number of designer drugs that are being abused."

The European Union, for example, is monitoring 15 other methcathinone analogues alone, while Japan recently placed 51 designer drugs under control. The INCB is recommending generic bans on such substances.

"Given the health risks posed by the abuse of designer drugs, we urge governments to adopt national control measures to prevent the manufacture, trafficking in and abuse of these substances," said Ghodse.

The INCB's schizophrenic report -- increase access to licit opioid pain medications, continue to ban new drugs -- reflects its bifurcated mission. At the same time it is charged with ensuring an adequate supply of medicines to the world, it is also charged with preventing non-medical use and diversion.

Vienna
Austria

Minnesota Head Shop Owner Says Fake Marijuana Ban Won't Work

Location: 
Duluth, MN
United States
Jim Carlson, the owner of a head shop, says a new federal ban on the sale of five chemicals used to make synthetic marijuana won't make much difference - he'll just stock brands that use other, still-legal substances. Carlson said that with about 210 similar chemicals available, the manufacturers will try to keep one step ahead of the government. "Unfortunately he is correct," said Barbara Carreno, a DEA spokeswoman in Washington, who confirmed Tuesday that many suppliers are offering retailers products with new chemicals. "There are many of these substances and we chose five common ones because we don't have the resources to study all of them."
Publication/Source: 
Minnesota Public Radio (MN)
URL: 
http://minnesota.publicradio.org/display/web/2011/03/01/fake-pot/

Synthetic Marijuana Widely Used at Naval Academy, Some Midshipmen Say

Location: 
Annapolis, MD
United States
A synthetic form of marijuana is widely used at the U.S. Naval Academy because it cannot be detected in routine drug tests, according to several former midshipmen. Since its introduction at the academy last year, synthetic marijuana has become popular among rank-and-file midshipmen and on the football and wrestling teams. Some isolated corners of the historic Annapolis campus have become well-known gathering spots for smoking it.
Publication/Source: 
The Washington Post (DC)
URL: 
http://www.washingtonpost.com/wp-dyn/content/article/2011/02/27/AR2011022703605.html

DEA Bans Synthetic Marijuana

By the time you read these words, the possession and sale of synthetic cannabinoids will be a federal crime. The DEA announced late Monday afternoon that its emergency rules banning the fake weed would go into effect Tuesday, March 1.

No legal highs for you, silly Americans! (Image via Wikimedia)
In recent years, synthetic cannabinoids sprayed on herbal matter and marketed as incense under names including Spice and K2 have become widely available. They are sold at head shops, convenience stores, truck stops, and via the Internet. The effects of such concoctions mimic those of marijuana.

The ban was originally scheduled to go into effect on Christmas Eve, but was delayed by legal challenges from retailers. The ban lists five chemicals commonly used in the compounds.

There has been "a rapid and significant increase in abuse of these substances in the United States," the DEA notice said. The agency is acting to avoid "an imminent hazard to public safety," it said.

But just as synthetic cannabinoids mimic the effects of herbal marijuana, the adverse effects reported by a subset of users mimic those of herbal marijuana. Those adverse effects include anxiety, paranoia, rapid heartbeat, and nausea -- all admittedly unpleasant, but not life threatening. No fake weed overdose deaths have been reported.

States have not been waiting for the feds to act against this legal high. At least 18 of them have criminalized synthetic cannabinoids, including Utah, Arizona, and Nebraska in the last week.

Washington, DC
United States

"Bath Salts," Fake Marijuana Banned in Utah

Utah has become the latest state to ban new synthetic drugs. Gov. Gary Herbert (R) signed into law Friday HB 23, which bans both synthetic cannabinoids and mephedrone, or "synthetic cocaine." The "emergency" measure went into effect immediately upon being signed by the governor.

No more buzz from Spice or "Bath Salts" in the Beehive State (Image via Wikimedia)
Synthetic cannabinoids are typically marketed as incense under brand names including Spice and K2. They are currently banned in more than a dozen states, with action pending in others. The DEA attempted to implement a nationwide ban as of Christmas Eve, but was blocked by legal moves on the part of retailers' groups until Tuesday, when a federal ban went into effect.

Mephedrone, a derivative of methcathinone, the stimulant substance found in the khat plant, is commonly sold as "bath salts," under names like Ivory Wave. Users report that it has cocaine-like or amphetamine-like effects. It has also been banned in Alabama, Florida, and Louisiana. The DEA has not yet moved against mephedrone.

The Utah law criminalizes 17 synthetic chemicals, all synthetic cannabinoid or methcathinone variants. They now go on the state's list of controlled substances, and their possession, sale, or manufacture becomes a criminal offense.

Gov. Herbert said after signing the bill that he didn't expect that to be the end of it. "Things change," he said. "What we face today is different than 10 years ago, and I expect my grandchildren will face different situations in the future."

Salt Lake City, UT
United States

Synthetic Marijuana Now Banned in Nebraska

Nebraska banned synthetic marijuana February 24, as an emergency measure passed by the legislature and signed a day earlier by Gov. Dave Heineman (R) went into effect.

No legal Spice for you, Cornhuskers! (Image via Wikimedia)
The bill, LB 19, adds a group of synthetic cannabinoid compounds to Schedule I of the state's Controlled Substances Act, and will punish their possession, production, and distribution like marijuana.

"It slams the door on manufacturers," said bill sponsor Sen. Beau McCoy (R), dealing a blow to the state's so far invisible synthetic pot manufacturing industry.

Synthetic cannabinoids mimic the effects of marijuana. The chemicals are typically sprayed on herbs and then packaged and marketed under names like Spice and K2. Such products began appearing in recent years and gained popularity as a legal alternative to pot, but their appearance also excited reflex prohibitionist instincts among police and politicians across the land.

Nebraska joins more than a dozen states that have moved against fake pot. The DEA had moved to ban the substances nationwide as of last Christmas Eve, but that effort had been blocked by organized retailers' groups until the DEA announced that the federal ban had gone into place Tuesday.

Lincoln, NE
United States

Virginia Legislature Passes Fake Marijuana Bills

By a vote of 98-0, the Virginia House Monday passed its version of a bill, HB 1434, that would outlaw synthetic cannabinoid products. Three days earlier, the state Senate passed its version of the bill, SB 745, on a 37-0 vote.

Busy with bans in Richmond (image via Wikimedia)
The House bill adds synthetic cannabinoids to the state's list of controlled substances, but the Senate bill does not. The House bill also has stiffer penalties for violators. That means the two bills will have to be reconciled for the ban to move to the governor's desk.

Products containing synthetic cannabinoids are sold in convenience stores, corner gas stations, and head shops in states where they have not been outlawed, and are also available on the Internet. They are typically marketed as incense and are sold under a variety of names, including Spice and K2.

The products are billed as a legal marijuana substitute, but hospital emergency rooms and poison control centers have reported numerous calls from people agitated or paranoid after using them. Still, the symptoms do not appear to be life-threatening, and no overdose deaths have been reported.

The DEA moved in November to take emergency action to institute an emergency federal ban on synthetic cannabinoids, but so far, that action has been blocked by legal action from retailers' associations.

Thirteen states have already banned synthetic cannabinoids. Similar actions are pending in a number of other state legislatures this year.

Richmond, VA
United States

Researchers Meet to Discuss Cannabinoid-Based Stroke Therapy

Location: 
Philadelphia, PA
United States
The Cannabinoid Discussion Group at Temple University reviewed a recent scientific publication from a German Laboratory. The presenter was Zachary Reichenbach, an MD/Ph.D student at Temple, who is currently working in the laboratory of Dr. Ron Tuma. The Tuma lab is focused on studying cannabinoid based therapies for the treatment of cerebral ischemia resulting from stroke. Reichenbach led the discussion on a research paper which showed that the cannabinoid JWH-133 activates the cannabinoid type 2 receptor (CB2R), resulting a decrease in infarct size or brain damage during reperfusion following an ischemic event.
Publication/Source: 
Examiner.com (CO)
URL: 
http://www.examiner.com/medical-marijuana-in-philadelphia/researchers-meet-to-discuss-cannabinoid-based-stroke-therapy

Schumer Wants to Ban Synthetic "Bath Salts" Drugs

Sen. Charles Schumer (D-NY) told the Associated Press Saturday that he wants the federal government to criminalize the new synthetic stimulant drugs mephedrone and MPDV (methylenedioxypyrovalerone). Although he said he was announcing a bill Sunday, it had yet to be filed as of Monday afternoon.

mephedrone ad (image via Wikimedia)
Marketed as "bath salts" under brand names including Ivory Wave, Zoom, and White Lightning, and sold in head shops, convenience stores, and corner gas stations across the land, as well as on the Internet, the drugs have effects on users similar to those of cocaine or amphetamines.

The substances are already banned by emergency action in three states -- Florida, Louisiana, and Mississippi -- and similar actions are likely in other states. Alarm-raising press reports are typically followed by hasty administrative or legislative action at the state house.

Now, Sen. Schumer wants to ban the substances nationwide. The bath salts "contain ingredients that are nothing more than legally sanctioned narcotics," he said.

The DEA is aware of the bath salts drugs and have them listed as drugs of concern, but it has so far not moved to enact a ban.

Drug War Chronicle has been following the mephedrone story for the past year. Read our recent overview here.

Washington, DC
United States

Retailers Fight Efforts to Ban "Fake Marijuana" [FEATURE]

Although the DEA's bid to ban synthetic cannabinoids at the federal level has been stymied, at least temporarily, bills to ban it at the state level are moving through legislatures in at least a half-dozen states and more will probably follow this year. They are already banned in a dozen other states. But retailers' representatives say that "fake pot" is a multi-billion dollar a year industry that should be regulated, not prohibited.

synthetic marijuana -- gone in some states, going in others? (image via Wikimedia)
In products going under a variety of brand names, such as Spice and K2, and sold widely in head shops, convenience stores, and gas stations, as well as via the Internet, synthetic cannabinoids are sprayed onto dried plant matter. Although the products are marketed as incense and sometimes marked "not for human consumption," they are typically smoked by purchasers in a bid to replicate a marijuana high with a legal substance.

While advocates of banning the synthetic cannabinoids describe them as harmful and dangerous, there is little evidence they are addictive or especially toxic. There are no known overdose fatalities from Spice, although at least one suicide has been linked by grieving parents to recent use. Other reported adverse effects of synthetic cannabinoids include panic attacks, anxiety, agitation, rapid heartbeat, vomiting, hallucinations, tremors, and seizures.

The American Association of Poison Control Centers reported last week that it had received more than 2,800 calls about Spice last year and another 217 through January 18. The calls were "causing increased concern among doctors and clinicians," the group said.

"These products present a health risk that is not worth it for consumers," said Missouri Poison Center Medical Director Anthony J. Scalzo, MD, who first noticed increased calls about these products to his center last fall. "The products are meant to create a similar reaction to marijuana, but in fact, patients often report the opposite -- a fast, racing heartbeat, elevated blood pressure and nausea."

But representatives of retailers say the concerns are overblown. They point to a relatively low number of reported adverse events, a lack of evidence of life-threatening side effects, and fending off Puritanism as reasons to regulate instead of prohibit synthetic cannabinoids.

"My estimate is that this industry is worth $2 to $3 billion at the retail level, so we are talking about up to 100 million $30 doses," said Dan Francis of the Retail Compliance Association, the group representing retailers that forced the DEA to back away, at least for now, from its emergency ban on synthetic cannabinoids. "If we're talking about 3,000 reports to poison control centers, it would seem that the incidence of problems is extremely low."

Francis also reacted to some of the hyperbolic rhetoric surrounding the danger of synthetic cannabinoids and the need for emergency action. "The typical side effects that are being reported are anxiety, agitation and nervousness," he said. "There are no reports of any side effects lasting more than a few hours."

"These substances are very widely used and they've been around for awhile. They're sold in head shops across America and a large number of gas stations, and there have been a few cases where people have freaked out and gone to the hospital, but that happens with marijuana, too," said Dustin Bayer of the Small Business Alliance, a group representing entrepreneurs challenging the federal ban effort. "It's not physical problems, but more like anxiety attacks."

The complaints of the retailers' representatives notwithstanding, bills to ban the synthetics are moving in the following states:

In Arizona, HB 2167, an emergency measure adding synthetic cannabinoids to the state's list of dangerous drugs and providing the same penalties as those for marijuana, passed the passed the House Judiciary and the House Rules committee last week on unanimous votes. It now heads to the House Floor.

In Indiana, SB 57, which outlaws synthetic cannabinoids and punishes them like marijuana, passed the Senate on a 47-0 vote last Friday. Two days earlier, the House Criminal Codes Committee approved its version of the bill. It now awaits a House floor vote.

In Minnesota, HF 57, which make sale of fake pot a gross misdemeanor punishable by a year in jail and possession a misdemeanor punishable by 90 days in jail, passed the House Public Safety Committee Monday and has been referred to the house Judiciary Policy Committee.

In Utah, HB 23, which would add synthetic cannabinoids to the state's controlled substances list, passed the House Health and Human Services Committee and is headed for the House Floor. A less restrictive bill that would ban their sale to people under age 19, HB 200, passed the House Law Enforcement and Criminal Justice Committee, but its sponsor said he would withdraw it if the more draconian bill passed.

In Virginia, SB 748, which add a new category of controlled substances to include synthetic cannabinoids, was passed by the Senate Committee on Courts and Justice Tuesday. The bill would make punishments similar to those for marijuana.

In West Virginia, SB 63, which would ban fake pot in the Mountaineer State, passed the Senate Health and Human Services Committee Tuesday, but only after being amended. The original version of the bill also included a ban on salvia divinorum, but that was dropped in the version approved by the committee.

Indiana state Sen. Ron Alting (R-Lafayette), who sponsored the Indiana ban bill, provided a typical rationale in an interview with the South Bend Tribune. "This is something that is just a real, real bad substance," he said, adding that "the hallucinations produced by synthetic cannabinoids are 10 times stronger than those from marijuana."

Alting said doctors and police had told him of people falling into comas, being temporarily paralyzed, or trying to kill themselves after using fake pot. And he said teenagers in his home district convinced him of the need for a ban when he asked them why anyone would smoke synthetic cannabindoids.

"They looked at me and said, 'Because it's legal,'" he said."Let's put an end to that comeback from young people and anyone else using this."

"Why do they want to make criminals out of store clerks?" asked an exasperated Francis. "It's an insane endeavor to enforce felony-quality laws on people who are just struggling to get by. Why don't they consider regulation instead? There's a myriad of those chemicals out there -- we could have good manufacturing regulations, batch and lot numbers, restricting it to people over 21. Those are the kinds of things we're working on right now."

"I would ask those legislators what danger does this pose?" said Bayer. "There is no shown danger. The people who want to ban it want to ban it for moral reasons, the same way they want to ban marijuana. It's not a scientific issue or an issue of danger, it's really more of a moral issue."

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