Drug Policy Reform

By  Robert L. DuPont, MD,President, Institute of Behavior and Health, a  501(c)3 non-profit organization working to reduce illegal drug use through the power of good ideas.

Often overlooked in discussions of drug policy today is the nature of the drug problem. The global drug problem can be traced to the innate nature of the human brain. The mammalian brain is extremely vulnerable to chemicals that stimulate brain reward. These chemicals are drugs of abuse. They produce far more intense brain reward than any natural reward, even sex and food. The repeated use of drugs of abuse leads to addiction. In its definition of addiction, the American Society of Addiction Medicine notes that it is “characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.”

Addiction is a chronic, often fatal, illness that typically begins in adolescence. The earlier an individual uses drugs of abuse, including alcohol and marijuana, the more likely it is that the person will develop a substance use disorder later in life. The best way to prevent addiction is to prevent the use of these substances. As a 13-year-old said to me years ago, “I don’t want to try cigarettes because I might like them.”

Modern Drug Use Epidemic

While the biology of addiction has not changed for millions of years, over the past half century drug use has changed dramatically. In the modern drug abuse epidemic, whole populations are exposed to a mind-bending array of drugs of abuse by powerful routes of administration. This has never happened before in human history.

Marijuana, the most widely used illegal drug, has been transformed in the time since the peak of its use in the United States in 1978. The potency of marijuana, as measured by the level of THC (the primary active cannabinoid in marijuana), has tripled over this time. New modes of marijuana consumption have increased the potency of marijuana delivery. For example, butane hash oil contains dramatically higher levels of THC, with concentrations up to 90 percent.

The addiction landscape also has changed as a result of the non-medical use of legal prescription drugs. Eighty percent of the global opioid supply is consumed by Americans who constitute less than five percent of the world’s population. With widespread medical use of opioid analgesics has come an epidemic of opiate dependence. The number of drug overdose deaths in the US has surpassed highway fatalities. The widespread use of prescription drugs has led to changes in the demographics of heroin use and subsequent heroin overdoses. Forty years ago heroin addiction was mostly confined to young inner-city men who often were involved in criminal activities. The new demography of heroin is the result of the demography of those that use pain medications non-medically. An estimated half of young heroin users previously abused prescription opioids prior to their heroin use. Heroin addiction has reached all parts of the country, especially small towns and rural areas, and is no longer limited to minority, male or lower income populations.

The drug epidemic continues to evolve in complex ways even as the public attitudes toward the use of drugs are shifting. Attitudes today are far more permissive toward the “recreational” use of drugs, especially marijuana. National polls indicate that a growing majority of Americans now favor legalization of marijuana for “recreational” use by adults.

Well-Funded Lobby Pushes for Marijuana Normalization

The well-funded lobby promoting the normalization of the use of marijuana (and other drugs) is based on the erroneous premise that marijuana is not only safe but also beneficial. (Ed. note: Three billionaires have spent an estimated $200,000,000 to legalize marijuana.) In contrast to this view, the science is clear that marijuana use is a serious threat to health, safety and productivity. As the negative impact of legal marijuana in the states of Colorado and Washington – and in the states that permit “medical” marijuana – is more widely understood, attitudes toward permissive drug use will shift once again.

The US, and the entire world, is at a crossroads in drug policy today with two oppositional perspectives on the future of drug policy. On the one hand is the vision on which current global drug policy was established in the first decades of the 20th century with the US in the lead which separates medical use from non-medical use of drugs with abuse potential. Under this framework, the goal of drug policy is to limit the use of drugs of abuse to medical uses only. Drugs of abuse are provided only through the process of physicians’ prescriptions and dispensed at pharmacies in a closed system and only for the treatment of diseases. The use of drugs of abuse outside of this very limited medical practice and their sale is illegal, punishable by the criminal law.

This well-established formulation of drug policy now is threatened by an alternative vision that treats drugs of abuse the way alcohol and tobacco are treated: through regulated production and sale to adults for legal use for any purpose. The campaign for this alternative drug policy begins with the legalization of marijuana but the stakes are far greater because it applies to all drugs of abuse and because there are enormous potential profits to be earned in this new marketplace. This move erases the sharp line between legal and illegal drugs. Erasing this line frustrates prevention and it opens the floodgates to widespread drug use.

Addiction Goes Up When Percent Usage Increases

When considering the potential public health impact of the legalization of drugs of abuse, including marijuana, it is helpful to consider the rates of use of the two legal drugs. Among Americans age 12 and older, 52 percent used alcohol and 27 percent used tobacco in the past month whereas 9 percent used any illegal drug. Only 7 percent of Americans used marijuana. Treating marijuana – to say nothing of other drugs of abuse – the way alcohol and tobacco are treated most certainly will increase availability and with it dramatically increase the level of marijuana use to a level that is similar to the use of the two currently legal drugs.

Is increased marijuana use and subsequent proportional increases in marijuana addiction in the interest of the nation’s public health? I don’t think so. The use of alcohol and tobacco are the two leading causes of preventable illness and death in the United States. Adding a third legal drug will add to the devastation that these legal drugs already generate.

NFIAAmericaondrugs
Usage can only go up if legalized.      Graphic Source: National Families in Action

What is the better answer for the future of drug policy, if it is not the legalization and regulation of drugs of abuse? The future of an effective drug policy lies in finding ways to reduce the use of drugs of abuse that are compatible with modern values and laws. This search for better ways to reduce illegal drug use is the focus and the agenda of the Institute for Behavior and Heath, Inc. (www.ibhinc.org). There are many good new ideas for drug policy, all based on the recognition of the vulnerability of the brain to the excessive, unnatural stimulation of brain reward mechanism by drugs of abuse which leads to addiction for millions of people and the resulting devastation suffered by these individuals, their families and their communities.

Rather than embrace drug legalization, we must develop innovative policies and programs that reduce the use of drugs of abuse and we must provide assistance, including quality treatment that achieves long-term recovery, to those with substance use disorders.

Robert L. DuPont, M.D.
President, Institute for Behavior and Health, Inc.
Former Director, National Institute on Drug Abuse (1973-1978)
Former White House Drug Chief (1973-1977)

(Editor’s Note–Original article, “The Changing State of Drug Policy,” is reprinted with permission from the Institute of Behavior and Health website, where footnotes align exactly with text.  It publishes several excellent articles about the influence of drug policy on addiction, drugged driving,etc.)

 


American Society of Addiction Medicine. (2011). Public Policy Statement: Definition of Addiction. Chevy Chase, MD: American Society of Addiction Medicine. Available: http://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2011/12/15/the-definition-of-addiction
National Institute on Drug Abuse. (2010). Drugs, Brains and Behavior: The Science of Addiction. NIH Pub No. 10-5606. Rockville, MD: National Institute on Drug Abuse, National Institutes of Health, US Department of Health and Human Services. Available: http://www.drugabuse.gov/sites/default/files/sciofaddiction.pdf
Drug Enforcement Administration. (2014). The Dangers and Consequences of Marijuana Abuse. Washington, DC: Drug Enforcement Administration Demand Reduction Section, US Department of Justice. Available: http://www.justice.gov/dea/docs/dangers-consequences-marijuana-abuse.pdf
Manchikanti, L., Fellows, B., Ailinani, H., & Pampati, V. (2010). Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective. Pain Physician, 13(5), 401-435. Available: http://www.painphysicianjournal.com/2010/september/2010;13;401-435.pdf
Centers for Disease Control and Prevention. (2014). Prescription Drug Overdose in the United States: Fact Sheet. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. Available: http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html
Kuehn, B. M. (2014). Driven by prescription drug abuse, heroin use increases among suburban and rural whites. JAMA, 312(2), 118-119.
Johnson, K. (2014, April 17). Heroin is a growing threat across USA, police say. USA Today. Available: http://www.usatoday.com/story/news/nation/2014/04/16/heroin-overdose-addiction-threat/7785549/
National Institute on Drug Abuse. (2013, April). Heroin. DrugFacts. Rockville, MD: National Institute on Drug Abuse, National Institutes of Health, US Department of Health and Human Services. Available: http://www.drugabuse.gov/sites/default/files/drugfacts_heroin_final_0.pdf
Cicero, T. J., Ellis, M. S., Surratt, H. L., & Kurtz, S. P. (2014). The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry, 71(7), 821-826.
Pew Research Center. (2014, April 2). America’s New Drug Policy Landscape. Washington, DC: Pew Research Center. Available: http://www.people-press.org/files/legacy-pdf/04-02-14%20Drug%20Policy%20Release.pdf
Volkow, N.D., Baler, R.D., Compton, W.M., & Weiss, S.R.B. (2014). Adverse health effects of marijuana use. The New England Journal of Medicine, 370(23), 2219-2227.
Richter, K. P., & Levy, S. (2014, June 11). Big marijuana—lessons from big tobacco [Perspective]. The New England Journal of Medicine. Available: http://www.nejm.org/doi/full/10.1056/NEJMp1406074
Substance Abuse and Mental Health Services Administration. (2013). Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration.


Established in 1978, the Institute for Behavior and Health, Inc. (IBH) is a 501(c)3 non-profit organization working to reduce illegal drug use through the power of good ideas. IBH websites include: www.ibhinc.org, www.StopDruggedDriving.org, www.PreventTeenDrugUse.org, and www.PreventionNotPunishment.org.

Marijuana Treats Look Like Familiar Sweets

pot headsIn the first 5 months of this year,  nine children had been treated at the Colorado Children’s Hospital in Aurora for ingesting marijuana.  Seven of these children were in intensive care.    By August, at least 3 more children had been in emergency treatment for marijuana at the same hospital.

The first stores for recreational marijuana opened in January, 2014.  Marijuana overdoses in children began October, 2009, when medical marijuana suddenly exploded in Colorado.  There were no such incidences recorded between 2005 and 2009, according to Dr. George Wang, head of emergency services at Colorado Children’s Hospital.  He explained the problem in a Colorado Public Radio interview last year.   Colorado’s medical marijuana was approved by voters in 2000, but the expansion of medical marijuana in 2009 caused the new problem.  The pace doubled this year, as a commercialized marijuana industry started selling new products.  “Legalizing creates greater promotion…. and also legitimizes the drug,” according to Bob Doyle, who was featured in a video we shared.firecrackers

In response to two deaths from edible marijuana, the governor signed legislation to regulate marijuana in May.  The laws will go into effect in 2016.  Edible pot will require child-proofing, as is required for pharmaceutical and over-the-the-counter medicine.

Despite labels, many of the children who have been hospitalized were too young to read.    A TV investigation showed that most children can’t tell the difference between the “adult candies” and those that are only for children.  Previously,  we published pictures of commercial pot candies available in Colorado, and in California.  Here’s an additional sampling.

pot drinksEven when parents try to keep it away from them, children go for sweets.  Cartoon-like characters and bright colors will always attract children.   It’s logical that school-age  children could be so attracted to the packaging that they would not bother to read.

Both the manufacturing of marijuana sweets and the packaging make them so appealing.  Edible pot processors make products that closely imitate familiar products, like Cap’N Crunch cereal and Pop Tarts. One company’s Pot-tarts are hard to distinguish from Kellogg’s Pot-tarts.poptarts

The Hershey Co. has filed a trademark infringement lawsuit against TinctureBelle, a Colorado marijuana edibles company, claiming it makes four pot-infused candies that too closely resemble iconic products of the chocolate maker.

The specific lollipopsproducts which mimic the look of Hershey’s candies are: Ganja Joy, like Almond Joy; Hasheath, which looks like Heath Bars; Hashees which resemble Reese’s peanut cups, and Dabby Patty, made to look like York peppermint patties.  The company’s website says its products “diabetic safe and delicious” and helpful with a variety of issues, including pain, headaches and insomnia.

Hershey says the products are packaged in a way that will confuse consumers, including children. The lawsuit alleges that TinctureBelle “creates a genuine safety risk with regard to consumers” who may inadvertently eat them thinking they are ordinary chocolate candy.   Other pot candies that look like Kit Kats, Milky Ways, Nestle’s Crunch and Butterfingers.  Will other candy companies like Nestles or Mars file a lawsuits, also?

pot candies

“Not so Fast”

This 4-1/2-minute video by Heather Sells of CBN News, Clearing the Smoke: The Real Costs of Legal Pot, exposes what legalizing means for the children of Colorado.

 

Twice as many 8th graders in Denver use pot than elsewhere in the country. Tax revenue is less than expected.  Wake up Americans to the hidden costs of marijuana legalization.  It is a great video to show if your politicians are promoting legalization.

Here’s the web article, published with the video in April 2014.

Myths About Marijuana

This Video comes from the Concordance Blog and is dated 2012.

This video deals exclusively with the documented negative health consequences of recreational cannabis use.

I used data from over 140 papers in the process of preparing this video. I’ve done my best to document sources. Below are some key papers for reference.

1. CANNABIS USE AND RISK OF LUNG CANCER: A CASE-CONTROL STUDY
Eur Respir J. 2008 February; 31(2): 280–286.

2. Possible role of marijuana smoking as a carcinogen in the development of lung cancer at a young age.
J Psychoactive Drugs. 1994 Jul-Sep;26(3):285-8.

3. Associations between duration of illicit drug use and health conditions: results from the 2005-2007 national surveys on drug use and health.
Ann Epidemiol. 2010 Apr;20(4):289-97.

4. Cannabis and road crashes: a survey of recent French studies.
Ann Pharm Fr. 2006 May;64(3):192-6.

5. Drugs in fatally injured young male drivers.
Public Health Rep. 1985 Jan–Feb; 100(1): 19–25.

6. Dose related risk of motor vehicle crashes after cannabis use.
Drug Alcohol Depend. 2004 Feb 7;73(2):109-19.

7. Developing limits for driving under cannabis.
Addiction. 2007 Dec;102(12):1910-7.

8. The effect of cannabis compared to alcohol on driving.
Am J Addict. 2009; 18(3): 185–193.

9. If cannabis caused schizophrenia–how many cannabis users may need to be prevented in order to prevent one case of schizophrenia? England and Wales calculations.
Addiction. 2009 Nov;104(11):1856-61.

10. Cannabis and suicide: longitudinal study.
Br J Psychiatry. 2009 Dec;195(6):492-7.

11. Cannabis use and the risk of developing a psychotic disorder.
World Psychiatry. 2008;7(2):68-71.

12. Delta-9-tetrahydrocannabinol effects in schizophrenia: implications for cognition, psychosis, and addiction.
Biol Psychiatry. 2005 Mar 15;57(6):594-608.

13. Adverse health effects of non-medical cannabis use.
Lancet. 2009 Oct 17;374(9698):1383-91.

14. General and oral health implications of cannabis use.
Aust Dent J. 2005 Jun;50(2):70-4.

15. Adverse health effects of non-medical cannabis use.
Lancet. 2009 Oct 17;374(9698):1383-91.

16. Adverse effects of cannabis on health: an update of the literature since 1996.
Prog Neuropsychopharmacol Biol Psychiatry. 2004 Aug;28(5):849-63.

17. Evaluating the drug use “gateway” theory using cross-national data: consistency and associations of the order of initiation of drug use among participants in the WHO World Mental Health Surveys.
Drug Alcohol Depend. 2010 Apr 1;108(1-2):84-97.

18. Does marijuana use serve as a gateway to cigarette use for high-risk African-American youth?
Am J Drug Alcohol Abuse. 2008;34(6):782-91.

There are another dozen or so papers I would like to include here, but will not for the sake of brevity.
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