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How to Prevent Opioid Overdoses? Provide Hard-Core Addicts Free Pharmaceutical Heroin

With Ohio beset by a massive public health crisis around opioid use and overdoses -- more than 4,000 Ohioans died of opioid overdoses in 2016 -- the Cleveland Plain Dealer sent travel editor Susan Glaser to Amsterdam in search of innovative approaches to the problem. While there, she rediscovered Holland's longstanding, radical, and highly-effective response to heroin addiction and properly asked whether it might be applied to good effect here.

The difference in drug-related death rates between the two countries is staggering. In the US, the drug overdose death rate is 245 per million, nearly twice the rate of its nearest competitor, Sweden, which came in second with 124 per million. But in Holland, the number is a vanishingly small 11 per million. In other words, Americans are more than 20 times more likely to die of drug overdoses than Dutch.

For Plain Dealer readers, the figures that really hit home are the number of state overdose deaths compared to Holland. Ohio, with just under 12 million people, saw 4,050 drug overdose deaths in 2016; the Netherlands, with 17 million people, saw only 235.

What's the difference? The Dutch government provides free heroin to several score hardcore heroin addicts and has been doing so for the past 20 years. Public health experts there say that in addition to lowering crime rates and improving the quality of life for users, the program is one reason overdose death rates there are so low. And the model could be applied here, said Amsterdam heroin clinic operator Ellen van den Hoogen.

"It's been an enormous success. I think it would work elsewhere," she told Glaser.

It already has. The Dutch program was modeled on a similar effort in Switzerland, which has also proven successful. Germany and Canada are among the several other countries with similar programs.

The Dutch approach is an example of the country's policy of gedogen (pragmatic tolerance), the same principle that led the Dutch to pioneer quasi-legal access to marijuana in the 1980s. It is also rooted in the notion that, for some, drug addiction is a chronic disorder, not a condition to be "cured," and one that can be treated with supervised drug use under clinical supervision. And the complete cessation of drug use need not be the ultimate goal; rather, the Dutch look for reductions in criminal activity and increases in the health and well-being of the drug users.

"It's not a program that is meant to help you stop," acknowledged van den Hoogen. "It keeps you addicted."

That's not a sentiment sits well with American moralizers, such as George W. Bush's drug czar, John Walters, whom Glaser consulted for the story. He suggested that providing addicts with drugs was immoral and not "real treatment," but he also resorted to lies about what the Dutch are doing.

He claimed the Dutch are "keeping people addicted for the purpose of controlling them" and that the Dutch have created "a colony of state-supported, locked-up addicts."

Actually, the Dutch are dealing with older, hardcore addicts who have repeatedly failed to quit after repeated stints in treatment, including methadone maintenance therapy, and they are neither "controlling them" or locking them up. Instead, the people in the program show up at the clinic twice a day, get their fix, then go about their business. This heroin-assisted treatment (HAT) allows those hardcore users to live less chaotic and more productive lives.

And heroin-assisted treatment is "real treatment," said Peter Blanken, a senior researcher with the Parnassia Addiction Research Centre in Rotterdam. He pointed out that one-quarter of program participants make a "complete recovery," including better health and quitting illegal drugs and excessive drinking. Many others continue to use heroin, but do so with better outcomes, he said.

There is also a real safety benefit to using state-supplied pharmaceutical heroin. It's potent, but it's a known quantity. Users face no risk of adulteration with more dangerous drugs, such as fentanyl, which is deeply implicated in the current US overdose crisis.

In the current political atmosphere in the United States, providing heroin to hardcore addicts is a hard sell indeed. Other, lesser, harm reduction interventions, such as needle exchanges remain controversial, and the country has yet to see its first officially sanctioned safe injection site. And drug decriminalization, which has led to a dramatic reduction in heroin addiction and overdose deaths in Portugal, remains off the table here, too. But with an annual drug overdose death toll of more than 50,000 people a year, it may time to start asking how many more Americans we are willing to sacrifice on the altar of moralistic drug prohibition.

Chronicle AM: OK Medical Marijuana Muddle, Toronto Health Board Says Decriminalize, More... (7/17/18)

The uproar in Oklahoma grows louder after the state health board messes with the medical marijuana initiative, Toronto's health board endorses drug decriminalization, and more.

A battle is brewing in Oklahoma after the state health board messes with the voter-approved medical marijuana initiative. (DPA)
Medical Marijuana

Oklahoma Pressure Mounts for Special Session on Medical Marijuana. Amid growing outrage over the Board of Health's imposition of restrictive and controversial changes to State Question 788, approved last month by voters, legislators and others are demanding Gov. Mary Fallin (R) call a special session of the legislature to ensure the will of the voters is upheld. Among other changes, the Board banned the sale of smokable marijuana and required pharmacists to be present at dispensaries. "This is not what the voters voted for," said state Rep. Jason Lowe (D-Oklahoma City). "We must adhere to the will of the people. The governor's signing of the emergency rules adopted by the Oklahoma State Health Department is an affront to democracy, an insult to the law-abiding citizens that showed up to vote for this initiative."

Drug Testing

Massachusetts High Court Holds Judges Can Require Drug Users to Remain Drug-Free. The state's Supreme Judicial Court ruled Monday that a judge can require a drug user to stay drug-free as a condition of probation. The case involved Julie Eldred, who was on probation for a larceny charge when she was jailed for failing a drug test. Her attorney argued that her relapse was a symptom of her disease of addiction and that it was unconstitutional to punish someone for a medical condition. But the court disagreed: "In appropriate circumstances, a judge may order a defendant who is addicted to drugs to remain drug-free as a condition of probation, and that a defendant may be found to be in violation of his or her probation by subsequently testing positive for an illegal drug."

International

Toronto Public Health Board Calls for Drug Decriminalization. The health board in Canada's largest city has called on the federal government to decriminalize all drugs. The board voted unanimously Monday to endorse the recommendation from the city's top health officer, Dr. Eileen de Villa. "The potential harms associated with any of these drugs is worsened when people are pushed into a position where they have to produce, obtain and consume those drugs illegally, so that's what we're trying to address," de Villa said, with a call for a "public health approach" focused on treatment and harm minimization rather police, courts and jail. Officials in Vancouver have also called for drug decriminalization, but the federal government of Prime Minister Justin Trudeau hasn't shown any appetite for it.

Chronicle AM: OK Medical Marijuana Kerfuffle, UK Gov Won't Block Festival Pill Testing, More... (7/12/18)

Oklahoma voters approved a medical marijuana initiative last month, but now a new battle is brewing; the British government says it will not block pill testing at clubs and festivals, and more.

The battle over medical marjuana is just beginning in Oklahoma. (Creative Commons)
Marijuana Policy

Massachusetts US Attorney Says Enforcement of Federal Pot Laws Will Be Limited. US Attorney Andrew Lelling warned that he won't "immunize" state residents from federal law enforcement, but that he will focus on overproduction, targeted sales to minors, and organized crime. Lelling also said that fighting opioid addiction remains his highest priority.

Medical Marijuana

Oklahoma Governor Signs Strict Medical Marijuana Rules. Gov. Mary Fallin (R) on Wednesday signed rules regulating medical marijuana that include banning the sale of smokable marijuana at dispensaries and requiring a pharmacist at dispensaries. "These rules are the best place to start in developing a proper regulatory framework for medical marijuana, with the highest priority given to the health and safety of Oklahomans. They are also the quickest and most cost-efficient way to get the process actually started as required by the law passed by the people. I expect modifications could occur in the future. I know some citizens are not pleased with these actions," Fallon said in a statement.

DEA Says Oklahoma Pharmacists Dispensing Marijuana Would Violate Federal Law. Although Gov. Mary Fallin (R) on Wednesday signed into law regulations requiring that a pharmacist be present at medical marijuana dispensaries, the DEA's Special Agent in Charge in Oklahoma, Rich Salter, warned that the medical marijuana program as a whole violates federal law. Any pharmacist who dispensed an illegal drug would be at risk of losing his or her license, he added.

Oklahoma Medical Marijuana Groups Vow To Take Action In Last-Minute Regulation Changes. The Oklahoma Cannabis Trade Association and the Oklahomans for Health, the group that spearheaded the successful medical marijuana initiative, held a news conference Wednesday to decry regulations imposed by the state Board of Health and signed into law by Gov. Mary Fallin (R). "Those are not reasonable," said medical marijuana advocate Nora Sapp. "We the people spoke on July 26th. We didn't ask permission. We told them what we are going to do." The two groups said they would fight the regulations.

International

British Government Says It Won't Block Pill Testing at Festivals. The British government has said it "would not stand in the way" of pill testing at music festivals and clubs. Policing minister Nick Hurd said that the Home Office would defer to the judgment of local officials in allowing festivals and live music venues to allow illicit drugs to be evaluated for safety. "The fact that chief constables in Avon, Cumbria, Somerset, and Hampshire have stepped forward and said… we do want to cooperate with this, sends a strong signal."

Advocates Claim "Overdose Prevention" Bill Would Drive People Out of Treatment and Increase Overdoses [FEATURE]

A bill ostensibly aimed at reducing opioid overdoses passed the House last month, but rather than cheering it on, drug treatment and recovery advocates are lining up to block it in the Senate. That's because instead of being aimed at reducing overdoses, the bill is actually a means of removing patient privacy protections from some of the most vulnerable people with opioid problems, including people using methadone-assisted therapy to control their addictions.

The measure is now before the Senate. (Creative Commons)
And that, advocates say, is likely to increase -- not decrease -- opioid overdoses by pushing users away from drug treatment out of fear the information they reveal could be used against them. The fear is real: Unlike other medical conditions, drug addiction leaves patients open to criminal prosecution, as well as stigmatization and other negative social consequences if their status as drug treatment or maintenance patients is revealed.

This bill, H.R. 6082, the Overdose Prevention and Patient Safety Act, would remove drug treatment patients' ability to control the disclosure of information to health plans, health care providers, and other entities, leaving them with only the lesser privacy protections afforded to all patients under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

"The confidentiality law is often the only shield between an individual in recovery and the many forms of discrimination that could irreparably damage their lives and future," said Paul Samuels, President/Director of the Legal Action Center. "Unfortunately, there is a very real danger of serious negative consequences for people whose history of substance use disorder is disclosed without their explicit consent."

The Legal Action Center is spearheading the effort to block this bill with the Campaign to Protect Patients' Privacy Rights, which counts more than a hundred organizations, including the American Association for the Treatment of Opioid Dependence, AIDS United, Community Catalyst, Faces and Voices of Recovery, Facing Addiction, Harm Reduction Coalition, National Advocates for Pregnant Women, National Alliance for Medication Assisted Recovery and the, National Council on Alcoholism and Drug Dependence.

The current patient privacy protections, known as 42 C.F.R. Part 2 ("Part 2"), were established more than 40 years ago to ensure that people with a substance use disorder are not made more vulnerable to discriminatory practices and legal consequences as a result of seeking treatment. The rules prevent treatment providers from disclosing information about a patient's substance use treatment without patient consent in most circumstances. The bill's plan to replace Part 2's confidentiality requirements with HIPAA's more relaxed standards would not sufficiently protect people seeking and receiving SUD treatment and could expose patients to great harm, the advocates charge.

"They should call this the Taking Away Protections Act," said Jocelyn Woods, head of the National Alliance for Medication-Assisted Recovery. "People will be afraid to go into treatment. I'm getting emails from people who want to leave treatment before this happens. If I were going into a program and they can't tell me my information will be safe, I would think about turning around and walking out," she said.

"Many of us would not have gone to treatment or accepted services if we thought that our information would have been shared with other entities without our permission. We would not have put our careers, reputation or families at risk of stigma and discrimination if we were not assured that information about our substance use disorder was safe and would only be shared with our consent," added Patty McCarthy Metcalf, executive director of Faces and Voices of Recovery.

The push for the bill is being led by health information software companies and behavioral health providers, such as Hazelden and the Betty Ford Center, and it prioritizes convenience over patient privacy.

"This is because the behavioral health people see complying with the privacy requirements as a pain in the ass," said Woods. "They're going to have to fix their computer systems to block out any treatment program licensed by the federal government -- not just methadone programs -- and they don't want to do that. One of the software companies, Netsmart, complained that they don't want to mess with their programming," she said.

"We need Part 2," Woods continued. "It keeps police out of the program. Without it, police can walk right in. They already sit outside methadone clinics and bust people for DUI on the way out. If this passes, they will walk right in. If the police see anyone they think has a warrant or committed a crime, they're gone."

While the bill has made its way through the House, advocates are hopeful it will stall in the Senate.

"The House pushed this through because they wanted to look like they were doing something and because the behavioral health people were pushing for it," Woods said, "but my sense is that it's moving slowly in the Senate. We have this crazy president, and there's immigration, and the congressional break, and then campaign season. My hope is we can push this past the elections and a blue wave in November will give us a fighting chance."

But the campaign isn't taking any chances and is mobilized to fight on the Hill in the next few months to block the bill. As Mark Parrino, President of the American Association for the Treatment of Opioid Dependence warned: "In the midst of the worst opioid epidemic in our nation's history, we cannot afford to have patients fearful of seeking treatment because they do not have faith that their confidentiality will be protected."

Can Magic Mushrooms Treat Cocaine Dependency?

The hunt for a pharmacological agent to help people strung out on cocaine get off the marching powder has been a long one, and non-traditional types of treatments are among the possibilities being studied. Ibogaine is one pharmacological therapy being studied. Another is href="https://www.uab.edu/news/research/item/9565-study-can-taking-a-hallucinogen-curb-cocaine-use" target=_blank_>psilocybin, the chemical that puts the magic in magic mushrooms.

Scientists at the University of Alabama-Birmingham's (UAB) School of Public Health are now conducting a clinical trial to see whether psilocybin can help break cocaine addiction.

The trial currently has almost 20 people enrolled, but researchers are looking for more subjects -- people who are currently using cocaine and have a strong desire to quit.

"Our goal is to create a tool or drug that provides significantly better outcomes for individuals addicted to cocaine than those that currently exist," said Sara Lappan, Ph.D., a postdoctoral scholar in the Department of Health Behavior

In the trial, participants receive a dose of psilocybin and are monitored for six hours, about the duration of the experience. Then, the researchers track his or her cocaine use.

"Our idea is that six hours of being under the effects of psilocybin may be as productive as 10 years of traditional therapy," Lappan said.

The researchers theorize that psilocybin works on three levels: the biochemical, the psychological, and the spiritual. In terms of biochemistry, psilocybin disrupts brain receptors thought to reinforce addictive behaviors. Psychologically, the drug is believed to reduce cravings, increase motivation, and increase one's sense of self-efficacy. Spiritually -- or transcendentally -- psilocybin (along with other psychedelics) is thought to increase both a person's sense of purpose and his or her sense of universal connectedness or oneness.

"If our hypotheses are supported, this has the potential to revolutionize the fields of psychology and psychiatry in terms of how we treat addiction," Lappan said.

But don't run out and start gobbling down magic mushrooms to quit cocaine just yet, the researchers cautioned.

"We aren't advocating for everyone to go out and do it," said Peter Hendricks, Ph.D., associate professor of health behavior in the School of Public Health at UAB. "What we are saying is that this drug, like every other drug, could have appropriate use in a medical setting. We want to see whether it helps treat cocaine use disorder."

They're not the only ones looking into the secrets of psilocybin. UAB is one of a half-dozen universities studying its potential medicinal benefits. The others are Johns Hopkins University, Imperial College London, New York University, University of California-San Francisco and Yale.

This article was produced by Drug Reporter, a project of the Independent Media Institute.

Chronicle AM: OK Legalizes MedMJ, Colombia Drug War Could Be Gearing Up, More... (6/27/18)

Oklahoma voters pass a very progressive medical marijuana initiative, legalizers win the Democratic gubernatorial nominations in Colorado and Maryland, Maine passes a major medical marijuana overhaul, and, with rightists now in power in Washington and Bogota, it looks like a new drug war is looming in Colombia.

Cocaine supply is at record levels and Colombia's newly elected president wants to do something about it. (CBP)
Marijuana Policy

Marijuana Legalizers Win Democratic Gubernatorial Nominations in Two States. Colorado US Rep. Jared Polis, a leading congressional proponent of marijuana legalization, won the nomination in his state, while former NAACP head Ben Jealous, who has also called for marijuana legalization, won the nomination in Maryland.

Florida Medical Marijuana Proponent Now Wants 2020 Legalization Initiative. Orlando attorney John Morgan, the man behind the state's successful 2016 medical marijuana initiative, now says he wants to put a legalization initiative on the 2020 ballot. It would "pass overwhelmingly," Morgan said. The longtime Democratic fundraiser pointed to President Trump's recent comments on marijuana: "And I believe in light of President Trump's position, America is ready and willing."

Texas Poll Has Narrow Majority for Legalization. More than half of Texas registered voters polled in the newest University of Texas/Texas Tribune poll support legalizing marijuana. Some 53% said they favored legalizing either small amounts (30%) or any amount (23%). Another 31% would support legalizing medical marijuana, leaving only 16% against legalizing marijuana in any form. A much larger majority -- 69% -- supported reduced penalties for the possession of small amounts.

Medical Marijuana

Maine Legislature Passes Medical Marijuana Overhaul. The legislature has passed a sweeping overhaul of the state's medical marijuana program. The bill removes current qualifying conditions and allows doctors to recommend medical marijuana for any ailment and allows caregivers to expand their operations in exchange for tighter regulations. The bill now goes to the desk of Gov. Paul LePage.

Oklahoma Legalizes Medical Marijuana. One of the reddest of red states went green on Tuesday. Voters in Oklahoma approved a remarkably progressive medical marijuana initiative by a healthy margin of 56% to 43%. The initiative, State Question 778, allows registered patients to possess up to three ounces of marijuana anywhere and up to eight ounces at home. Patients also have the right to grow up to six mature and six immature plants or have designated caregivers do it for them. It also creates a system of licensed dispensaries, cultivation, and processing facilities and sets taxes at a relatively low 7%. The initiative also bars localities from using zoning laws to block dispensaries (although they wouldn't be allowed within 1,000 feet of a school). But what is most striking about Question 778 is that it does not restrict access to medical marijuana to a list of qualifying conditions. In fact, the initiative language explicitly states that "[T]here are no qualifying conditions" and that the only limitation on a doctor's recommending medical marijuana is that it must be done "according to the accepted standards a reasonable and prudent physician would follow when recommending or approving any medication."

Harm Reduction

Ohio Officials Dragging Feet on Federal Needle Exchange Funds, Advocates Charge. The advocacy group Harm Reduction Ohio is accusing the state Health Department of using a bureaucratic delaying tactic to prevent needle exchange programs from accessing any of the funds the state is expected to receive for HIV prevention. Group head Dennis Cauchon said the department is failing to submit a necessary form to the federal Centers for Disease Control and Prevention. "Preventing HIV, hepatitis and drug overdoses are crucial health measures and save massive amounts of money and treatment," Cauchon wrote. Surrounding states submitted the necessary paperwork in 2016, he noted. "The Ohio Department of Health's refusal to support this would be nothing short of reckless, irresponsible and ignorant."

International

UNODC Says Cocaine, Opium Supplies at Record Levels. In its 2018 World Drug Report released Tuesday, the UN Office on Drugs and Crime (UNODC) reported that both cocaine and opium supplies were at their highest ever recorded levels last year. UNODC also described the non-medical use of prescription opioids, such as fentanyl, as a major threat to public health. "Drug markets are expanding, with cocaine and opium production hitting absolute record highs, presenting multiple challenges on multiple fronts," said UNODC Executive Director Yury Fedotov in a statement. "The real problematic issues for us have been the increase in opium production in Afghanistan and the massive increase in cocaine production, particularly because of Colombia," added Thomas Pietschmann, a drug research expert at the UNODC, and one of the lead authors of the report.

Colombia's New Rightist President-Elect Welcomes Trump's Support in New War on Drugs. President-elect Ivan Duque said Monday he welcomed Donald Trump's support for his agenda of a "head-on fight against drug trafficking" during a congratulatory phone call from the US leader. "Today I received a call from the US president where he congratulated us for the results achieved in the last elections and also his commitment to support our security, justice agenda, our agenda of a head-on fight against drug trafficking," Duque told reporters. The US wants Duque to clamp down hard on coca cultivation, which is at record levels. During the campaign, Duque vowed to reinstate the forced eradication of coca crops and the aerial spraying of herbicides over coca farms.

Colombia's Outgoing President Authorizes Use of Drones for Aerial Coca Eradication. Outgoing President Juan Manuel Santos on Tuesday authorized the use of drones to spray herbicides on coca crops. The move comes a day after the US said Colombian coca cultivation had increased 11% last year and cocaine production jumped 19%. Santos' government suspended aerial eradication of coca crops with glyphosate in 2015 after the World Health Organization linked it to cancer. Using low-flying drones would limit the dangers associated with glyphosate, he said.

(This article was prepared by StoptheDrugWar.org's 501(c)(4) lobbying nonprofit, the Drug Reform Coordination Network, which also pays the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

Chronicle AM: Canada Legalizes Marijuana! (6/20/18)

Canada has become the second country to legalize marijuana after final votes in parliament Tuesday, the Supreme Court agrees to hear an Indiana asset forfeiture case, Eleanor Holmes Norton files a bill to allow marijuana in public housing in states where it's legal, and more.

Marijuana Policy

Eleanor Holmes Norton Files Bill to Allow Marijuana Use in Public Housing Where It's Legal. Rep. Eleanor Holmes Norton (D-DC) has filed a bill that would allow residents of public housing in states and localities where marijuana is legal to use it at home without fear of being evicted. Under Norton's bill, a person may not be denied federally-assisted housing for the use of marijuana in jurisdictions where medical or recreational marijuana has been legalized. Under Norton's bill, smoking marijuana would be treated the same as smoking tobacco in federally-assisted housing. The bill is not yet available on the congressional website.

Asset Forfeiture

Supreme Court Agrees to Hear Indiana Civil Asset Forfeiture Case. The US Supreme Court has agreed to hear the case of an Indiana man who used the proceeds of his father's life insurance policy to buy a $42,000 Land Rover only to have the vehicle seized after he was caught selling heroin with it. When authorities moved to forfeit the vehicle, Tyson Timbs challenged the action and won in the Grant Superior Court, with the judge finding the vehicle was purchased legally and that its forfeiture would be "grossly disproportionate" to Timb's offense. The Indiana Court of Appeals agreed, noting that the maximum fine for Timbs' offenses was only $10,000 and suggested the seizure amounted to an "excessive fine." The state Supreme Court then reversed, Timbs appealed, and here we are.

Reproductive Rights

Federal Appeals Court Panel Rejects Wisconsin Woman's "Cocaine Mom" Lawsuit. A three-judge panel on the US 7th Circuit of Appeals on Monday dismissed a lawsuit challenging Wisconsin's "cocaine mom" law, which permits the detention of pregnant women who are suspected of abusing drugs. The panel dismissed the case because the woman, Tammy Loetscher, had moved out of the state. A US district court judge last year found the law unconstitutional and issued an injunction barring it from being enforced, but the law has remained in force while the state appealed. The appeals court panel's ruling leaves the law in force for now. "Today's decision means that all women in Wisconsin have to worry that when they seek health care, if there's even a chance they might be pregnant, the state can take them into custody, lock them up in a drug treatment program, a mental hospital or a jail -- whether or not drug treatment is really needed," said Nancy Rosenbloom, director of legal advocacy for the National Advocates for Pregnant Women, which represented Loertscher.

International

Canada Legalizes Marijuana. With final votes in the House of Commons and Senate on Tuesday, the Canadian parliament has approved the marijuana legalization bill, C-45. The bill legalizes the possession of up to 30 grams in public and allows the cultivation of up to four plants per household. It will also allow for regulated and taxed marijuana businesses, with regulations of sales left to the provinces. Provincial and territorial governments need s few weeks to prepare for retail sales, so the actual rollout of legalization is expected to happen in mid-September.

Australia Festival Pill Testing a Success, Should Be Emulated, Report Finds. A study released Wednesday by the Safety and Testing Advisory Service at Festivals and Events finds that pill testing at the Groovin the Moo festival in Canberra in April was "an overwhelming success" and the federal government should take a leadership role in introducing a plan for broader pill testing. "The pilot demonstrated that such an intervention is possible and that people are willing to use the service, despite the limitations arising from the tight timelines, inauspicious physical infrastructure and the lack of dissemination strategies on-site during the festival," the report said. Less than half the drugs tested at the festival were relatively pure.

Different Psychedelics Share a Common Trait: Enhancing ‘Neural Plasticity"

New research suggests that different classes of psychedelic drugs all share the tendency to promote the growth of new brain cells, especially the kind that reach out and forge connections with other brain cells. This finding could help explain both the mind-expanding properties of the drugs and the mechanisms by which they appear to act as valuable treatments for a broad range of psychiatric disorders.

Earlier research had identified the dissociative anesthetic ketamine as promoting growth in key brain cells (as well as being a fast-acting and effective treatment for depression), but this new research finds similar effects in amphetamine-based psychedelics such as DOI (2,5-dimethoxy-4-iodoamphetamine), ergoline psychedelics (such as LSD), and tryptamines (such as DMT).

Using experiments in cell culture and with animals, researchers led by Dr. David Olson of the University of California at Davis found that various classes of hallucinogenic drugs acted on the structure and function of cortical neurons using the same mechanisms as ketamine. The findings could point to new treatment approaches for depression, anxiety, PTSD, and addiction, the researchers wrote last Tuesday in the peer-reviewed journal Cell Reports.

"The state-of-the-art, prototypical, fast-acting antidepressant is ketamine -- a compound that promotes neural plasticity and repairs circuits involved in mood and anxiety disorders," Olson told MedPage Today. "Our work demonstrates that psychedelics produce comparable effects on neuronal structure and function, providing a potential explanation for why MDMA, psilocybin, and ayahuasca seem to have antidepressant and anxiolytic effects in the clinic."

Using test tubes, as well as rats and fruit fly larvae, the researchers found that all of these classes of psychedelics increased "neural plasticity," the ability to create new connections among brain cells. The drugs all excited the growth of dendritic spines and axons, the cerebral hangers-on that brain cells use to reach out and create connections, or synapses, with other brain cells.

That's the opposite of what happens with depression, anxiety, PTSD, and addiction. The current theory is that these disorders may occur when neurites retract, not allowing brain cells to connect at synapses.

"One of the hallmarks of depression is that the neurites in the prefrontal cortex -- a key brain region that regulates emotion, mood, and anxiety -- those neurites tend to shrivel up," Olson said in a statement.

Olson's research found that the neural plasticity effect found with ketamine was also "remarkably potent" with even very small doses of LSD, which could help explain the popularity of "microdosing" among people seeking happier and more creative lives. Chemical compounds that mimicked psilocybin and MDMA also increased neural plasticity on the same level as ketamine, and that could mean new opportunities for researchers working with psychiatric disorders.

The studies also showed that the effect outlasted the action of the drugs. In rats, for example, psilocybin produced results that lasted for hours after the drug had left the body. Similarly, rats given a single dose of DMT not only saw an increase in dendritic spines similar to ketamine but saw that effect last for 24 hours when the drug itself had been eliminated within one hour.

This is potentially very good news for researchers working on treatments for anxiety, depression, and addiction, which all seem to act on the same brain circuits.

"Prior to this study, there was only one player in town and that was ketamine. This opens up some new doors," Olson said. "As the diversity of chemical structures capable of producing ketamine-like plasticity effects continues to grow, so does my hope that we will find a safe and effective fast-acting treatment for depression," he said.

This article was produced by Drug Reporter, a project of the Independent Media Institute.

Chronicle AM: House Passes "Dangerous" SITSA Act, NY Adds MedMJ for Opioids, More... (6/18/18)

Arizona Republicans go one way, Texas Republicans go another; the House passes the SITSA Act, New York will allow medical marijuana for opioid use, and more.

The House has passed a new, old school drug war bill. (Creative Commons)
Marijuana Policy

Poll: Arizona Republicans Still Don't Like Weed. A new poll from OH Predictive Insights finds that nearly three-quarters of state Republican primary voters oppose marijuana legalization. Only 21% were in favor. Still, a marijuana legalization nearly passed statewide in 2016.

Top New York Health Official Says Cuomo Panel Will Endorse Legalization. Dr. Howard Zucker, the state's top health regulator, said Monday a Cuomo administration panel will recommend that the state legalize marijuana. "We looked at the pros. We looked at the cons… the pros outweigh the cons," Zucker said of the panel's work.

Texas GOP Endorses Marijuana Decriminalization, More. At the party's state convention this past weekend, delegates approved platform planks calling for the decriminalization of marijuana possession, support for hemp farming, expanding access to medical marijuana, and calling for the rescheduling of marijuana.

Medical Marijuana

New York Health Department of Health Announces Opioid Use to be Added as a Qualifying Condition for Medical Marijuana. The Health Department on Monday announced it will develop a regulatory amendment to add opioid use as a qualifying condition for medical marijuana. "The opioid epidemic in New York State is an unprecedented crisis, and it is critical to ensure that providers have as many options as possible to treat patients in the most effective way," said New York State Health Commissioner Dr. Howard Zucker. "As research indicates that marijuana can reduce the use of opioids, adding opioid use as a qualifying condition for medical marijuana has the potential to help save countless lives across the state." Opioid use joins 12 other qualifying conditions under the state's Medical Marijuana Program. Currently, patients can be eligible if they have been diagnosed with one or more of the following severe debilitating or life-threatening conditions: cancer; HIV infection or AIDS; amyotrophic lateral sclerosis (ALS); Parkinson's disease; multiple sclerosis; spinal cord injury with spasticity; epilepsy; inflammatory bowel disease; neuropathy; Huntington's disease; post-traumatic stress disorder; or chronic pain.

Drug Policy

House Passes SITSA Act. Over the protests of drug reform and other groups, the House last Friday approved HR 2851, the Stop Importation and Trafficking of Synthetic Analogues (SITSA) Act. The bill has already passed out of committee and awaits a House floor vote. The bill is an old-school drug war response to new psychoactive substances that relies heavily on the criminal justice system. The Drug Policy Alliance called the bill "dangerous" because it grants the Justice Department "broad new powers to ban synthetic analog drugs, decide what the sentences should be, and take away the requirement for Congressional oversight that has been in place for 40 years." The bill now heads to the Senate.

International

France Poll for First Time Finds Majority for Marijuana Legalization. A new poll from the Institut français d'opinion publique (Ifop) for Terra Nova and Echo Citoyen, a think tank and a citizens' political group, for the first time reports a majority for legalization. The poll had support at 51%, with 40% opposed and 9% undecided. The poll marks a "turning point," said Thierry Pech, head of Terra Nova. "French people made the finding that prohibition and repression did not work to preserve the health of users," Pech said. Under current French law, pot possession is punishable by up to a year in jail and a fine of more than $4,000.

Making Matters Worse: DEA's Move to Restrict Opioid Prescriptions Pushed Users to the Dark Web

By the end of 2013, the country's quiet opioid addiction crisis was no longer so quiet. Opioid overdose deaths that year topped 16,000, more than four times the same statistic for 1999. That prompted a number of measures at the state and federal level to rein in opioid prescriptions, including a move by the DEA in October 2014 to tighten its policies around some of the most commonly prescribed opioids.

Dark Web fentanyl sales rose after the DEA restricted some prescription opioids. (Creative Commons)
The new DEA policy -- aimed at popular opioids such as Vicodin and Lortab -- imposed restrictions on doctors' prescribing and made it more difficult for patients to get refills. In one sense, the policy was a success: Prescriptions for those drugs decreased almost immediately. But new research adds to an increasing body of evidence that restricting opioid prescribing has not solved the opioid crisis but instead worsened it.

Since the DEA policy shift, opioid overdose deaths continued to grow with more than 40,000 fatal opioid overdoses in 2016. And while prescription opioid overdose deaths have slightly decreased -- there were about 14,000 that year -- overdose deaths from heroin and non-prescription synthetic opioids such as fentanyl went through the roof. Heroin and illicit synthetics accounted for nearly two-thirds of all opioid overdose deaths in 2016.

In the new study, published this week in the British Medical Journal, researchers examining the impact of the DEA policy shift found evidence that while the change indeed lowered prescribing rates for the opioids in question, it was also linked to an increase in illicit online sales of those drugs in Dark Web drug markets.

The researchers used software called DATACRYPTO to crawl encrypted Dark Web marketplaces where people can anonymously buy damned near anything, from drugs to guns to credit card numbers. DATACRYPTO harvested data on which drugs were for sale, their country of origin, and the number of customer comments on each seller's comments page. Researchers used that last figure as a proxy for how much of a drug that seller sold. They examined sales of prescription opioids, sedatives, stimulants, and steroids, as well as heroin. It was only with prescription opioids that they found a significant Dark Web sales bump.

Here's what they found: "The sale of prescription opioids through US cryptomarkets increased after the schedule change, with no statistically significant changes in sales of prescription sedatives, prescription steroids, prescription stimulants, or illicit opioids."

According to their data, prescription opioids doubled their market share of U.S. Dark Web drug sales thanks to the DEA policy change. By July 2016, opioids represented 13.7% of all drug sales in U.S. cryptomarkets, compared with a modeled estimate of 6.7% of all sales.

While the researchers were careful to not make claims of causation -- only correlation -- their conclusion speaks for itself: "The scheduling change in hydrocodone combination products coincided with a statistically significant, sustained increase in illicit trading of opioids through online US cryptomarkets. These changes were not observed for other drug groups or in other countries. A subsequent move was observed towards the purchase of more potent forms of prescription opioids, particularly oxycodone and fentanyl."

Not only is the DEA policy change linked to increased Dark Web opioid sales, it is also linked to a move toward more powerful, and thus more dangerous, opioids. The researchers noted that while fentanyl was the least purchased Dark Web opioid in the summer of 2014, it was the second most frequently purchased by the summer of 2016. Fentanyl killed as many people as prescription opioids that year.

This study -- one of the few that examines supply reduction (as opposed to demand reduction) as a means reducing drug use -- strongly suggests that supply-side interventions carry unintended consequences, especially the resort to more dangerous and more powerful substitutes. The study's authors refer to this effect as "the iron law of prohibition, whereby interventions to reduce supply, such as increased enforcement and changes to drug scheduling, lead to illicit markets dominated by higher potency products."

Perhaps better than restricting opioid prescriptions, which has deleterious impacts on the tens of millions of Americans suffering chronic pain, or other supply-side interventions, would be increased access to addiction treatment, as well as greatly expanded harm reduction measures to try to get people off opioids and keep them alive in the meantime.

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