What causes addiction? Easy, right? Drugs cause addiction. But maybe it is not that simple.
What causes addiction? Easy, right? Drugs cause addiction. But maybe it is not that simple.
In case you haven’t heard, there’s an opioid crisis in America.
With majorities of Americans now clearly supportive of marijuana legalization, opioids, a class of drugs used for thousands of years to treat pain and other ailments, have become the latest target of drug warriors and do-gooders alike.
“Our nation is in the throes of a heroin and opioid epidemic,” Attorney General Jeff Sessions said Wednesday. “Overdose deaths more than tripled between 2010 and 2014. According to the CDC, about 140 Americans on average now die from a drug overdose each day. That means every three weeks, we are losing as many American lives to drug overdoses as we lost in the 9/11 attacks.”
Indeed, according to the Centers for Disease Control and Prevention, more than 33,000 Americans lost their lives in 2015 due to opioid-related overdoses, including 12,989 deaths associated specifically with heroin.
Candidate Donald Trump suggested, of course, a border wall would help solve the problem, while President Trump has complained America is a “drug-infested” country where “drugs are becoming cheaper than candy bars.”
On the other side of the aisle, Democratic Senator Joe Manchin of West Virginia has gone so far as to call for a new war on drugs to combat apparent problem of opioid use, abuse and overdoses.
With so many Americans dying, it’s important to clarify a few things about opioids, the folly of knee-jerk government reaction and the need for harm reduction.
The exaggerated danger of opioids
Despite their reputation, opioids are neither especially addictive nor dangerous on their own.
Research has consistently shown that few individuals who are prescribed opioids ever actually develop a problem with them. A 2016 study by Castlight Health, Inc. suggested only about 4.5 percent of individuals who receive opioid prescriptions are abusers. A 2010 Cochrane review of 26 studies found reports of opioid addiction in only 0.27 percent of patients.
Meanwhile, guidelines issued by the CDC in 2016 for prescribing opioids for chonic pain cited another study which followed chronic pain patients who received opioid prescriptions for 13 years. The study found that “one in 550 patients died from opioid-related overdose” over the 13 years, which upon reflection is a remarkably low rate considering the demographic involved.
As for the dangerousness of opioids, one variable often left out in discussions of opioid overdose is the fact that opioid overdoses tend to involve multiple drugs.
A 2014 report from the CDC based on nationwide emergency room data noted that alcohol was involved in 22.1 percent of deaths related to opioid pain relievers, but conceded the figure could be higher, given wide varieties in how states and localities collect and report toxicology data.
Other, more focused studies have found incredibly high rates of drug mixing at play in opioid overdoses. A 2015 paper looking into opioid overdoses in San Francisco from 2010-2012 found that 74.9 percent of opioid overdose deaths involved other drugs, including cocaine (35.3 percent), benzodiazepines (27.5 percent) and alcohol (19.6 percent). Likewise, data from the New York City Department of Health and Mental Hygiene noted that “nearly all (97 percent) overdose deaths involved more than one substance.”
With respect to heroin specifically, as a 2003 article published in the Journal of Urban Health explained, “The overwhelming majority of overdoses, both fatal and nonfatal, involved the concomitant consumption of heroin with other drugs. The extensiveness of polydrug use among ‘heroin’ over-doses suggests that ‘polydrug toxicity’ is a better description of the toxicology of overdose.”
Rarely do mainstream media reports of the opioid crisis mention the prevalence of polydrug toxicity – except for the occasional surge in excitement over fentanyl, a highly potent opioid which unscrupulous drug dealers sometimes put into heroin to strengthen its effects. (Naturally, the mixture of fentanyl with heroin is more an unintended consequence of prohibitionist drug policies and a resistance to harm reduction approaches than anything else.)
Of course, it is much more politically lucrative to exaggerate the risk and danger of opioids than to acknowledge the relatively low risk of addiction and the likelihood that harm reduction efforts (like warnings against mixing opioids with other drugs) might save lives.
Government policies turned people to heroin
As the prescription and use of opioids surged in the first decade of the 2000s, so too did the number of people seeking addiction treatment and experiencing overdoses. Rather than take a measured approach, government officials instead pursued policies aimed at restricting access to prescription painkillers, criminalizing and arresting doctors and patients in the process.
The continued rise in overdose deaths only indicates these approaches haven’t worked to curtail abuse or death from opioid use and misuse.
Instead, individuals who previously used pharmaceutical opioids have increasingly been pushed towards heroin use, with heroin use in the United States the highest its been in 20 years. According to the Drug Policy Alliance, “Ninety-four percent of opioid-addicted individuals who switched from prescription opioids to heroin reported doing so because prescription opioids ‘were far more expensive and harder to obtain.’”
Of course, for people who have switched from pharmaceuticals to heroin due to lack of access to legal pain medication, or those who abuse either pharmaceuticals or heroin for whatever reason, government policy has only made them less safe.
And there’s plenty of reason to believe government policies have only made opioid and heroin use less safe than before. The increased number of deaths reported in 2016 happened despite decreases in the number of opioid prescriptions and the number of heroin users.
Despite the well-documented role of polydrug use opioid overdoses, it’s unlikely we’ll see proclamations from Jeff Sessions or Trump or any other prominent politicians warning people to engage in harm reduction when using opioids by foregoing alcohol, benzodiazepines or any other contraindicated drug that could heighten the risk of harm or death from opioid use.
Other ideas include getting allowing individuals with chronic pain to access the medication they need without criminalizing their ailment or threatening their doctors with prosecution. Or allowing the operation of safe injection sites and expanding access to medication-assisted treatment and access to syringe exchange programs and naloxone, which can effectively reverse opioid overdoses.
Of course, a border wall won’t solve the problems associated with opioid use and abuse, nor will an expansion or perpetuation of prohibitionist policies. Yet, Trump’s budget proposal includes $175 million in increased expenditures for the Department of Justice “to target the worst of the worst criminal organizations and drug traffickers in order to address violent crime, gun-related deaths, and the opioid epidemic.” It also, of course, includes calls for billions of dollars for his beloved wall. Furthermore, Jeff Sessions’ public proclamations have overemphasized the role of enforcement and drug abuse prevention ideas from the ’80s and ’90s.
Alas, the nation’s massive anti-drug bureaucracies and agencies need some way to stay afloat, even though their entire mission is predicated on the fraudulent idea that drug prohibition and enforcement will keep Americans safe and drug-free. Anti-drug crusades predicated on saving people from themselves or sinister chemicals may be dressed up in good intentions, but as history has shown, they are little more than ruses to further expand government intervention in our lives and bloat the budgets of government agencies.
The opioid crisis has claimed thousands of lives since its onset in Canada several years ago, and recently a Vancouver MP brought up a conversation about the necessity for our country to consider legalizing drugs in order to address growing public health concerns around overdose deaths.
Trudeau has promised Canadians legalization of weed, which won’t happen until 2018 most likely. If that is successful (and likely it will be considered successful once the dollars start rolling into the government’s coffers), there could be calls for further legalization of drugs as public attitudes soften.
But what would happen if Canada legalized drugs other than marijuana? We have seen full decriminalization, all the way from weed to heroin, in Portugal—but legalization is another concept entirely. Bill Bogart, who wrote the book Off The Street, which called for national discussion in Canada of this very topic, said that simply decriminalizing drugs only treats one side of the equation—it does not address drug supply issues.
“There’s no quality assurance of what is being sold [with just decriminalization], so in an illicit market, people can be sold tainted substances that can make them sick or even kill them,” Bogart told VICE. “If we legalize and regulate, people would know what’s in them, how potent they are, etc.” That reasoning is why legalization would need to be considered over simply decriminalization if Canada would want to use it as a way to remedy the destruction bootleg fentanyl has caused. By legalizing and regulating, the government could better ensure that substances people are consuming are not tainted, leading to a decrease in overdoses and deaths.
When it comes to legalization in Canada, however, a single country ending prohibition would have little effect on the global illicit drug market, including inhumane conditions in which drugs such as cocaine are produced. As Bogart said, an international effort toward ending prohibition would be necessary if we hope to address those kinds of problems.
“One of the central goals in legalization and regulation is to get rid of the misery that prohibition has caused… It’s generated an illicit market run by the lawless; if we legalize and regulate, we’ll confront that kind of market.”
“Just because we legalize and regulate, it doesn’t mean the illicit market will disappear the next day,” Bogart told VICE. “It will be driven out, and the object is to completely destroy it, but it will take time. Whatever portion of the market remains illicit, by definition, it’s not being taxed.”
That taxation is a major benefit to legalizing drugs, Bogart said, and soon we will get to witness firsthand a case study in what that looks like once we see the prohibition of marijuana in Canada officially end. The weed industry alone in Canada could have a value in the billions of dollars—if we considered legalizing other currently illicit drugs, the kind of revenue that would create could equal out to be a ridiculously huge amount of money.
“It’s hard to quantify; because it is an illicit market, we don’t have any good figures… It’s certainly [at least] a billion-dollar industry.”
We could see other drugs—like magic mushrooms and cocaine—sold in dispensaries like weed is pending their legalization. But, Bogart said, we are more likely to see legalization in waves, meaning single substances made legal in phases over time. Though he is for legalization, Bogart said he doesn’t think it will or should be done all at once.
“Attitudes and norms can change; we mustn’t despair of them never changing”
An additional benefit to taxing drugs in addition to marijuana, Bogart said, is that it is a form of harm reduction. The cost associated could impact our consumption.
“We’ll take the money we’ve spent on the criminal justice system and on the enforcement system, and use it to build a system of regulation, one aspect of which is harm reduction… The message would be become, ‘Well, we’re not going to put you in jail for this, but that doesn’t mean drugs are harmless.” Ending prohibition, Bogart said, would have a significant impact on decreasing our prison population in Canada. And additionally, harm reduction, ideally, would become embedded in our education system in order to educate children from a young age about the effects of different kinds of drug use.
However, the stigma and stereotypes rooted in the War on Drugs mentality will take time to shift. “Attitudes and norms can change; we mustn’t despair of them never changing.” Bogart said. “Marijuana will get to the same place as alcohol… We could develop corresponding attitudes toward other drugs, [such as accepting] cocaine use in a way where there’s no sign of dependence and you use it occasionally.”
Bogart believes the opioid crisis has reignited the important conversation around ending prohibition of substances other than marijuana in Canada, but that “there’s so many factors at play here. If Donald Trump and Jeff Sessions decide they are going to be drug warriors, this whole evolution is going to be enormously impeded.”
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Not only do marijuana users not have to worry about stroke risks later in life, but CBD oil can help cigarette smokers quit smoking.
Jan 15, 2017
We know it may seem counter-intuitive to what we already know about tobacco, but a steady stream of scientific research is revealing some surprising conclusions about cannabis. The latest research, published on December 27th, 2016, indicates that marijuana use does not run the same risk of stroke that tobacco does.
The study used a sampling of 49,321 Swedish men, born between 1949 and 1951 and were conscripted to military service at the age of 18 and 20. Their medical health questionnaire, completed upon conscription, served as the baseline data for the soldiers. And since Sweden’s healthcare system is nationalized, the national database was accessed to compare initial conscription data with longitudinal health data decades later.
Stroke data was analyzed from the 49,321 participants. The researchers concluded, “We found no evident association between cannabis use in young adulthood and stroke, including strokes before 45 years of age. Tobacco smoking, however, showed a clear, dose–response shaped association with stroke.” The conclusions may be a surprise to some, but probably not to cannabis users, whom many consider marijuana to be a good medicine.
In one related double-blind study, cannabidiol (CBD) was demonstrated to have helped research study participants reduce the number of cigarettes smoked daily. The study was conducted using 24 smokers. Twelve smokers were given a CBD inhaler and told to inhale the substance whenever they felt the urge to smoke. They were also not prevented from smoking. The other 12 were given a placebo inhaler and told to do the same.
Just last month, in December of 2016, the DEA made the highly controversial move to classify CBD oil as a Schedule I narcotic along with heroin, and cocaine. Good luck getting high on CBD as it does not and cannot get anyone high. The disgusting move on the part of the enforcement wing of the drug war should be immediately reversed on the grounds the DEA is heavily influenced by Big Pharma and is not making a clear headed decision and certainly not one which is best for the American people.
The aforementioned research studies show promise, not only for users of marijuana to feel more comfortable about the use of their medicine, but also for smokers of tobacco, those who are the highest risk for stroke, cancer, and emphysema. According to the American Cancer Society, “Tobacco use kills more than 6 million people annually, 30 percent of whom will die from cancer-related diseases due to smoking. If current trends continue, tobacco use will kill 8 million people annually by 2030, 83 percent of whom reside in low- and middle-income countries.”
So, we at The Free Thought Project continually ask the common sense line of questioning. Why is tobacco legal and marijuana illegal? Why isn’t tobacco on the list of schedule I narcotics? Why, if after decades and decades of research on Tobacco, is it allowed for purchase in all 50 states by those 18 and older?
Of course, no one is advocating for outlawing a substance that makes people happy — regardless of the health effects — however, the hypocrisy in this scenario is rife.
The logic that marijuana needs to be criminalized and users kidnapped, caged, and some even killed in police raids, all smacks in the face of common sense. It’s about time that the government heeds the published research on the study, ends the war on marijuana, and declassifies CBD as a narcotic. Enough is enough and we’re fighting back with information. Thanks to the latest research studies, we once again have more than enough evidence to show that marijuana is not only safe, and healthy, but has the potential to help others quit lifelong bad habits such as smoking cigarettes.
History has shown that drug prohibition reduces neither use nor abuse. After a rapist is arrested, there are fewer rapes. After a drug dealer is arrested, however, neither the supply nor the demand for drugs is seriously changed.
The arrest merely creates a job opening for an endless stream of drug entrepreneurs who will take huge risks for the sake of the enormous profits created by prohibition.►Prohibition costs taxpayers tens of billions of dollars every year, yet 40 years and some 40 million arrests later, drugs are cheaper, more potent and far more widely used than at the beginning of this futile crusade.
We at L.E.A.P.(Law Enforcement Against Prohibition)( http://www.leap.cc )believe that by eliminating prohibition of all drugs for adults and establishing appropriate regulation and standards for distribution and use, law enforcement could focus more on crimes of violence, such as rape, aggravated assault, child abuse and murder, making our communities much safer.
We believe that sending parents to prison for non-violent personal drug use destroys families. We believe that in a regulated and controlled environment, drugs will be safer for adult use and less accessible to our children. And we believe that by placing drug abuse in the hands of medical professionals instead of the criminal justice system, we will reduce rates of addiction and overdose deaths.
An editorial in the BMJ, the UK’s most widely-read medical journal, argues that laws against drug use have harmed people across the world, while stressing that drug addiction should be viewed as a health problem and police involvement must end.
The BMJ says the “war on drugs” has failed and “too often plays out as a war on the millions of people who use drugs.”
The call for reform reflects a shift in medical opinion. In June, Britain’s two leading health bodies, the Royal Society for Public Health and the Faculty of Public Health, called for the personal use of drugs to be decriminalized.
The group said criminalizing users deters them from seeking medical help and leads to long-term harm, such as exposure to hard drugs in prison, the breakup of families, and loss of employment.
Drug deaths in Britain are presently at an all-time high.
The BMJ says that the number of heroin fatalities has doubled in the past three years because of government policies. Official figures show that 579 people died from using heroin in 2012, compared with 1,201 in 2015.
The journal’s editor in chief, Fiona Godlee, says: “There is an imperative to investigate more effective alternatives to criminalisation of drug use and supply.”
She added that the government should “move cautiously towards regulated drug markets where possible” and doctors should “use their authority to lead calls for a pragmatic reform informed by science and ethics.”
Former Deputy Prime Minister Nick Clegg writes in the BMJ that the government could consider introducing a version of the Portuguese movement, where drug users are referred to treatment rather than being punished. Drug deaths have fallen in Portugal by 80 percent.
Last month, Glasgow councilors and police approved a plan to open the first “shooting gallery” or “fix room” in Britain, which will allow heroin addicts to inject safely under supervision.
The facilities aim to tackle drug-related deaths, the spread of infection among users, and the amount of needles and injecting equipment left in public areas.
There are about 90 similar injecting facilities operating worldwide, including in Australia, Germany, France, Holland, and Switzerland.
Complaints about the ban of kratom, often used by recovering opiate addicts, have been vociferous, but not always backed by facts.
While we have seen a surge in new psychoactive substances in recent years, there has also been a rediscovery in the West of old herbal narcotics that have traditionally been used in different parts of the world. One example is khat, the leaves of which are chewed for a mild stimulant effect in some societies in the Horn of Africa – it was banned in the UK in 2014. Another plant to come to the attention of the authorities is kratom, a tropical tree from Southeast Asia that has just been banned by the US Drug Enforcement Agency.
Kratom (Mitragyna speciosa) is a tropical tree that grows between four and 16 metres high and is indigenous to Southeast Asia, the Philippines and New Guinea. Like coca leaves in the central Andes, the chopped fresh or dried leaves of the kratom tree have been chewed for centuries or made into tea to combat fatigue.
The DEA’s ban places kratom as a schedule 1 controlled substance, alongside drugs like cannabis, heroin, MDMA (ecstasy) and LSD. It joins an ever-expanding list of psychoactive drugs deemed to have “no currently accepted medical use” and a “high potential for abuse”. There has been quite an uproar about this among kratom users, although both the arguments for and against lack consistent evidence.
The effects of kratom on humans are dose-dependent: small doses produce stimulatory effects resembling cocaine or amphetamines, while larger dosages tend to produce sedative-narcotic effects similar to opiate drugs such as opium, morphine or heroin. Kratom has become more popular in the West in recent years, especially among those seeking a more “natural high”. On the other hand, in Thailand and Malaysia, kratom was made illegal in 1943 and 2015 respectively.
Some kratom users claim that preparations can be used to treat opiate addictions. But data to support its effectiveness and safety is scarce, especially considering that these claims have been made on anecdotal evidence and have not followed the usual rigorous scientific procedures.
The chemistry of natural products is exceptionally complex, producing complex pharmacological effects. With scant data on the toxicology or safety profile of kratom, and even less regarding its interactions with conventional drugs or the effects of abusing it, there is ample risk for it to cause harm or even death by misadventure. So the question is not why the DEA considers kratom a menace to public health – which it at least has the potential to be – but rather why the agency continues to add psychoactive substances, new or newly rediscovered, to its lists of scheduled drugs.
The idea that an ever-expanding list of thou-shalt-nots has any effect on public health has not only been proven to be ineffective, it might even be counterproductive if not put in place as part of an across-the-board harm assessment. Kratom is a powerful opioid receptor agonist, which means that its supposed beneficial effect on opioid withdrawal symptoms stem from the fact it attaches to the same neurotransmitter receptors in the brain. In other words, it stimulates similar areas of the brain and mimics the effects of opiates, if not their toxicity.
Even taking the medicinal argument in support of kratom at face value, we should still require the same level of evidence required for any other substances used to help opiate withdrawal – methadone for example. The only study to support this claim is from a single country (Malaysia), is purely observational, and has a small sample size of just 136 people.
Both the DEA and kratom users are missing the point: neither banning nor legalising/decriminalising the drug will tackle the public health concerns that it might pose. The DEA conducts enforcement, not realising that whether or not kratom is banned, there will still be health effects that must be dealth with by health policy, not criminal justice. On the other hand, those in support of legalising or decriminalising kratom do not have a clear alternative of how to deal with the health effects that would follow.
Only a tiny minority of people use kratom in the West, and it is a drug most people will have never heard of. Users have shown themselves to be very vocal minority, with many belonging to a new type of online activist who favour volume over facts. The case for a medicinal use of kratom comes down to considerable wishful thinking.
When the DEA and its equivalent in other countries insist on banning substances this generally does little to interrupt supply. And it certainly ignores the heart of the issue: why people use drugs, what are the public health implications, how to engage with users effectively – particularly in a case such as this where there are such polarised views – and how to move debates on in a world where facts have become secondary to pursuing agendas.
At the end of the day, public policy is there to change behaviour for the good of society. The DEA has consistently tried to do so through banning and enforcement, but this has produced the opposite effect: drugs have never been more widespread, alongside the social damage from enforcement and health effects that are a consequence. In short, how long will we persist in fighting a lost drug war?