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This section is one that is very important to me. Not only is substance abuse the #1 cause of death in America, it is extremely destructive of the fabric of American families. I have worked for the past 12 years as the Research Director of Doctors & Lawyers for a Drug Free Youth, a citizen and research effort which I personally founded. I'm a big fan of drug testing. Urine test kits for marijuana and cocaine or marijuana and methamphetamine can be bought for $6. I have found marijuana tests for just $1 and co-nicotine tests for $2. Since marijuana is by far the most popular illicit drug in high school. I personally think it is a good policy for schools to have a random drug testing program as well as parents, employers, and others. I personally think that a change it drug law enforcement methodology could eliminate (decrease by 99%) illicit drugs from the U.S. within two years. I studied this in law school and did a thesis on my findings. Although my approach would cost no more money to implement and would within a couple years save billions of dollars if it worked, I was unable to interest several small, isolated jurisdictions in giving it a try.
Drug Abuse Studies 700% Increase in Drug Abuse Disorders in Family Members of Drug Addicts!: A study of 231 patients with dependence on opioids, cocaine, cannabis, and/or alcohol, and 61 controls, and 1267 relatives found an 8-fold increase of drug disorders among relatives of drug abusers across the wide range of specific substances, which was largely independent from familial aggregation of both alcoholism and antisocial personality. There was some specificity of familial aggregation of the predominant drug of abuse. Thus, family history is one of the most potent risk factors for drug abuse. Kathleen Merikangas, Yale, Arch Gen Psychiatry 5:973-979, ’98. Drugs More Available in U.S. Schools in 2005: 28% of middle-school-student respondents reported that drugs are used, kept or sold at their schools, a 47% jump since 2002, according to the 10th annual teen survey by Columbia's National Center on Addiction and Substance Abuse. The number of high schoolers saying drugs are at their schools rose 41% in the last three years, to 62%, the survey said. Twelve- to 17-year-olds who report that there are drugs in their schools are three times likelier to try marijuana and twice as likely to drink alcohol than teens who say their schools are drug free. Teens who viewed drugs as morally wrong were significantly less likely to try them, as were those who felt their parents would be "extremely upset" to discover drug use. The report found that teens who confided in their parents were at much lower risk of drug abuse than teens who turn first to another adult. The survey also found that teens who say they watch three or more R-rated movies in a typical month — about 43 percent — are seven times likelier to smoke cigarettes and six times likelier to try alcohol than teens who do not watch R-rated movies. The correlation between R-rated movie watching and the risk of substance-abuse remains even after controlling for age. The survey was conducted by phone and involved 1,000 randomly selected teens aged 12 to 17 years old and 829 parents. Twenty-six percent of the teens said someone nearby could hear their answers. The margin of sampling error is plus or minus 3.1 percentage points for the teens and plus or minus 3.4 percentage point for the parents. AP news story. Rebacca Carroll. 8/18/05. Amsterdam Drug Users Die at High Rate: In a 17 year follow-up of 899 participants in the Amsterdam Cohort Study among Drug Users, at least 27% had died within 20 years after starting regular drug use; for half, death had been due to causes unrelated to human immunodeficiency virus. Among those still alive, the estimated prevalence of abstinence for at least 4 months from the above drugs and methadone was only 27% at 20 years since initiation. A higher age at initiation, a calendar year of initiation before 1980, and a Western European ethnic origin were associated with higher prevalence of abstinence. "Maturing out" to a drug-free state does not apply to the majority of drug users. Long-term outcome of chronic drug use: the Amsterdam Cohort Study among Drug Users. Termorshuizen F, Krol A, et al. Amsterdam, the Netherlands. Am J Epidemiol. 2005 Feb 1;161(3):271-9 Heroin & Methadone Rx Better than Methadone Alone: Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials. Wim van den Brink, Vincent M Hendriks, Peter Blanken, Maarten W J Koeter, Barbara J van Zwieten, and Jan M van Ree. BMJ 2003; 327: 310. 8/9/03. Inhalable heroin (n = 375) or injectable heroin (n = 174) prescribed over 12 months. Heroin (maximum 1000 mg per day) plus methadone (maximum 150 mg per day) compared with methadone alone (maximum 150 mg per day). Psychosocial treatment was offered throughout. 12 month treatment with heroin plus methadone was significantly more effective than treatment with methadone alone in the trial of inhalable heroin (response rate 49.7% v 26.9%) and in the trial of injectable heroin (55.5% v 31.2%). Discontinuation of the coprescribed heroin resulted in a rapid deterioration in 82% (94/115) of those who responded to the coprescribed heroin. Buprenorphine Class III Alternative to Methadone: Partial opioid agonist at mu receptor. Prevents withdrawal but antagonist at high doses. Combined with naloxone = Suboxone. Sublingually TIW = methadone or LAAM (long-acting methadone) in 270 pt for 17 weeks (NEJM 2000; 343:1290 RE Johnson). $287/mo vs. $30 for methadone. Moonflower Seeds Hallucinogen: 14 teens in northeastern Ohio became ill after intentionally eating the seeds of Datura inoxia, a common decorative plant typically referred to as "moonflower. Each year a couple of deaths are reported from the use of anticholinergic plants like moonflower. Anticholinergic effects often occur, such as hallucinations, dilated pupils, tachycardia, and urinary retention. Mor Mortal Wkly Rep CDC Surveill Summ 2003;52:788-791. Kids in Broken Homes Use More Drugs: PRIDE 2000-1 survey of 75000 6th-12th grade students found 20.4% of students with both parents report using drugs in past year vs. 28.3% living with mother only, 29.8% mother and step-father, 31.9% father and step-mother, and 38.4% father only. AP 7/20/2001. Ecstacy May Cause Parkinson’s Disease: Baboons and squirrel monkeys both showed 60% to 80% damage to striatal dopaminergic neurons due to three doses of MDMA in a single night, a dosage similar to humans at rave parties. 90% damage in humans necessary for symptoms to be present, but this may only occur in later life. Johns Hopkins, Science 9/27/02. (Ed: Some commentators have pointed out that no cases have yet been seen despite widespread use.) ADHD and Conduct Disorder Common in Teen Substance Abusers: In a study of 600 youths ages 12-18 admitted to four different out-patient for marijuana problems, 50% were diagnosis marijuana dependence and 46% marijuana abuse. Only 20% thought they needed any help for substance abuse. 30% were comorbid with ADHD and conduct disorder. U S. Florida, Characteristics and problems of 600 adolescent cannabis abusers in outpatient treatment. Tims FM, Dennis ML, et al. Addiction 2002 Dec;97 Suppl 1:46-57 HIV, HCV Infections High in European Drug Users: HIV infections ranges from 32% of Spain IV users to 1% in England. HCV ranges from 40% to 90%. European drug use went up in 80s and early 90s and cannabis went up in the 90s. Europe was once much better than the U.S. and is now worse by almost every measure. Italy, Luxembourg, and Portugal are the worst. Lancet 12/1/01 Smoking Tobacco Higher in Netherlands Than U.S.: 34% Dutch adults smoke. Ned Tijdschr Geneeskd 2000 Nov 4;144(45):2138-42. Comparable rate in U.S. is 25%. No Benefit from Fighting Back Coalition: A study at the 12 Fighting Back sites found no decrease in substance abuse and sites; increased involvement actually had worse results. Denise Hallfors, Am J Prev Med ’02;23:237. The Fighting Back Coalition had been a project funded by the Robert Wood Johnson Foundation which has a long history of favoring treatment over law enforcement. Clonidine Used by Addicts: 46% of 38 methadone applicants admitted using clonidine, primarily for self-treated opioid withdrawal but also to experience psychoactive effects. J Subst Abuse Treatment ’98;15:589; Also ObGyn 97;90:790-4 in where 33% of 90 pregnant opiate abusers tested positive although only 7% admitted to using clonidine. They had bought it on the street. 1,4-butanediol Thunder Nectar: 2 fatalities reported. Used for sex arousal, date rape, euphroia, bodybuilding, depression, insomnia. Available on internet. Gamma-butyrolactone, a metabolite, banned by FDA. Cocaine Dependence Not Helped: Acupuncture no more successful than sham or no acupuncture. JAMA 1/2/02;287:55 Vigabatrin Seizure Drug Studied for Cocaine Abuse: Small 20 person 4 week rx with 4 week f/u open study of European seizure drug with daily users claimed sizable decrease and headline says drug helped. In fact, there were 8 drop outs and four more used cocaine. Only 8 lasted a month without cocaine. No control group! Study of little value but got lots of headlines. Drug causes tunnel vision so FDA won’t approve it. Liverpool. Synapse 9/24/03. LSD: Hallucinogen Persisting Perception Disorder Treated with Clonidine: 8 pt 21-26yo. HPPD for over 3 months without any drug use continuing. Clonidine 0.025 TID 2 months. CGI marked psychopathology 5.25 decreased to 2.5 meaning mild residual. Lerner, Israel, Int Clin Psychoph 00;15:35. Not a controlled study so this report isn't worth very much. Stimulant Abuse Sees Huge Increase: Global use of Ecstasy rose by 70 percent from 1995-1997 to 2000-2001, while use of amphetamines rose by 40 percent over the same period. More than 40 million people worldwide, or 1 percent of all people 15 years or older, used amphetamine-type stimulants, known as ATS, in 2000-2001, the report said. The report said seizures of the substances rose from about four tons in 1990-1991 to almost 40 tons in 2000-2001. It estimated the global value of the ATS industry at $65 billion a year. The report, by the Vienna-based U.N. Office on Drugs and Crime, said users are concentrated in Europe, North America and Asia, while manufacturers are found in the United States and Europe. 9/25/03 AP Rome Health Psychiatrists Usually Miss Substance Abuse Diagnosis Due to Not Asking: A London study of 200 consecutive psychiatric admissions to six different hospitals gave all patient a questionnaire to complete and compared the results to the chart notes. 97 (49%) scored 8 on AUDIT, indicating hazardous alcohol use—53% of men and 44% of women. Forty four (22%) scored 15 or above on AUDIT, indicating alcohol dependence. More than half of the patients (110; 58%) reported lifetime substance misuse, and 52 (27%) reported taking illicit drugs in the 30 days before admission. One patient had had a full alcohol history taken; 54 (27%) had partial alcohol histories in their notes. Three quarters of patients (146; 73%) had no record of using alcohol in their notes. Most patients (148; 74%) had no record of drug misuse in their notes. Substance misuse in psychiatric inpatients: comparison of a screening questionnaire survey with case notes. Ben Barnaby, assistant psychologist, Colin Drummond, professor of addiction psychiatry, Annie McCloud, clinical lecturer in addictive behaviour, Tom Burns, professor of community psychiatry, Nicola Omu. BMJ 2003;327:783-784
Thomas E. Radecki, M.D., J.D.
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