Recovery 2019: The Year in Review

From the Recovery Advocacy Update blog of the Hazelden Betty Ford Foundation originally posted on January 7, 2020.

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As Americans reflect on the past decade, the much more defining story, of course, was the opioid crisis, which fueled an unprecedented overdose epidemic that has barely begun to abate. Drug overdoses claimed a mind-boggling half-million lives in the 2010s and devastated countless others, while exposing the inadequacy of our nation’s overall approach and commitment to preventing and treating addiction, and supporting long-term recovery.

Amid the tragedy, we saw the beginning of positive change in addiction-related public attitudes, perceptions, policies, practices and systems. Hazelden Betty Ford has helped lead the way with many changes of its own. They began using opioid-addiction-treatment medications in 2012, and became a strong advocate for comprehensive care that includes medication options, psychosocial therapies and peer support. They emerged as a leading voice for breaking down barriers between the medical and Twelve Step communities.

Hazelden Betty Ford also transitioned to an insurance model so more people could access care; evolved away from the 28-day residential standard to a more individualized approach that enables people to stay engaged longer over multiple levels of care; launched a new era of aggressive collaboration with the broader healthcare field; made the evidence-based therapy “motivational interviewing” core to a more patient-centered clinical approach; initiated a new, innovative system for capturing and acting upon patient feedback throughout the treatment experience; developed new recovery coaching options; and much more. In addition, the foundation spoke up vigorously about the need for ethical and quality standards in recovery, and continued to support related industry reform efforts. It was a decade of big change for them, and they will likely evolve a great deal more in the 2020s, as they have consistently done since 1949.

Broader changes to the many systems that affect people with addiction are coming more slowly, but things seem to be pointed in the direction of progress. Indeed, most addiction specialists want addiction prevented and treated, rather than stigmatized and criminalized. The question arises, though: Does that mean it is wise to fully legalize and commercialize more addictive substances? Or are there policies and approaches in between that promote public health better than either extreme?

In the new decade, marijuana will be a case study and likely a defining story. The experiment with full legalization looks troubling so far. State-level data from the National Survey on Drug Use and Health finds that marijuana use in “legal” states among youth, young adults, and the general population continued its multi-year upward trend in several categories. New data and studies come in weekly, it seems—consistently showing cause for greater public health concerns. One of the foundation’s 2020 resolutions is to help ensure the facts about marijuana and the risks of expanded use get more attention.

One big concern, for example, is that marijuana vaping by teens surged in 2019, signaling that more adolescents are using the drug and consuming highly potent vape oils, according to new government data and drug-use researchers. Federal regulators are paying attention. They shut down 44 websites advertising illicit THC vaping cartridges, part of a crackdown on suppliers amid a nationwide spate of lung injuries tied to black-market cannabis vaping products.

The outbreak of severe lung injuries may have peaked, but cases are still surfacing, and the agency is urging doctors to monitor people closely after hospitalization, due to the risk of continued vaping. One Harvard graduate student writes, “I nearly died from vaping THC, and you could too.” Marijuana and vaping are both among the issues coming up on the campaign trail, and recent polling released by the National Council for Behavioral Health shows strong bipartisan agreement among registered voters in New Hampshire that the federal government is not doing enough to address mental health and addiction in America. Mental Health for US, a coalition trying to raise more awareness in the campaign, held a recent forum in New Hampshire. Watch the livestream replay here.

In Washington, the White House hosted a summit of its own on efforts to deliver mental health treatment to people experiencing homelessness, violence and substance use disorder. Watch Part 1 of the event, Part 2, and the President’s remarks. The Administration also issued its long-awaited vaping policy last week, with the FDA banning fruit, mint and dessert-flavored vaping cartridges but continuing to allow menthol- and tobacco-flavored cartridges as well as all flavored e-cigarette liquids. Many worry the guidelines don’t go far enough.

Since the foundation’s last update, the President also signed a $1.4 trillion spending package passed by Congress, averting a government shutdown. The package maintains funding levels for most areas relevant to the field of addiction counseling, with modest increases in a few SAMHSA grants as well as at the CDC and at the National Institutes of Health. Most notably, the legislation gives states more flexibility in spending State Opioid Response (SOR) grant funds; specifically, they’ll now be able to use the money to also address the growing problems associated with addiction to meth, cocaine and other stimulants. Here’s a thorough overview from our friends at the National Association of State Alcohol and Drug Abuse Directors.

If you are interested in more information about these topics or the Hazelden Betty Ford Foundation, please visit their website by clicking here.

If you or someone you know is struggling with substance use disorder and want more information or help quitting, please contact your local AA or NA chapter, or click here to visit the National Institute on Drug Abuse official website. You can also scroll back to the top of this post and click on the COMMENT bar to open an dialog with me. I will be glad to speak with you any time.

2019 Monitoring the Future Survey Raises Worries about Teen Marijuana Vaping

From the monthly blog of Dr. Lora Volkow,
Executive Director
National Institute on on Drug Abuse

Originally posted December 18, 2019

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For the second year in a row, rapid rises in vaping among adolescents are the top story from the Monitoring the Future survey of drug use and attitudes among the country’s 8th, 10th, and 12th graders. What became evident in 2018 was that vaping devices, which have exploded in popularity over the past several years, are now exposing a new generation to nicotine. Those trends continued in 2019, but with the additional concern of a rapid rise in the vaping of marijuana, as well as increases in daily marijuana use in 10th graders.

More than one fifth of high school seniors (20.8 %) reported having vaped marijuana in the past year, as did nearly that same proportion of 10th graders (19.4 %). From 2018 to 2019, the percentage of seniors vaping marijuana in the past month increased from 7.5 percent to 14 percent—the second largest one-year increase in any drug use that has ever been recorded in the 45-year history of the MTF survey. (The first largest increase was nicotine vaping from 2017 to 2018 reported last year.) Among 10th graders, past-month use was 12.6 percent.

Overall, marijuana use has held relatively steady over the past several years despite wider availability and diminished perception of the drug’s harms by this age group (and by the U.S. population more generally). But the increases in vaping of THC, the active ingredient in marijuana, are alarming for a number of reasons. For one thing, we don’t yet know if THC’s effects differ when vaped versus when smoked in a traditional fashion or whether the amount of THC that youth are being exposed to differs with these methods.

Also, the students took the survey in January of this year, which was before the alarming news this summer about serious lung illness and a number of deaths (48, as of this writing) in people using vaping devices. Most of the illnesses occurred in people who had vaped THC. It is not known whether the cause may have been contamination in certain black market vape fluids, or some other factor. The CDC has named vitamin E acetate as a chemical of concern in vape fluids, but it is too soon to rule out other chemicals or device attributes that may also contribute to the illnesses.

At this point, we know very little about the health and safety effects of administering THC at high concentrations, and this applies not only to vaping but also to smoking of concentrated THC products and new edible products and beverages coming on the market in states that have legalized marijuana for adult use. Research is urgently needed to answer these questions. However, marijuana is federally classified as a Schedule 1 substance. Scientists face administrative hurdles when studying Schedule 1 substances, and currently there are no provisions allowing federally funded researchers to study marijuana products coming from the black market or even from dispensaries in states where they are permitted to operate. Resolving these research barriers is an urgent priority.

Daily marijuana use has remained steady among 12th graders, at 6.4 percent, but this number conceals a very significant gender difference. Eight percent of male seniors report using marijuana daily, whereas 4.6 percent of females do. This suggests that a disproportionate percentage of male students may not be performing to their potential because of daily impairment by that drug.

Increased daily marijuana use by younger teens is another worrying trend in this year’s survey results. This year, 4.8 percent of 10th graders reported daily marijuana use, as did 1.3 percent of 8th graders. The brain is very much a work in progress throughout adolescence, and this is especially true at younger ages, so there is increased risk of long-term harms as well as addiction when 8th and 10th graders use any substance, including marijuana.

The continued increase in nicotine vaping by adolescents is also concerning. A quarter of 12th graders reported past-month vaping of nicotine, as did nearly 20 percent of 10th graders and nearly 10 percent of 8th graders. It is not yet leading to increased cigarette use in this age group—one of the many bright spots in this year’s survey is continued downward trends in smoking—but many public health experts worry that vaping will lead to nicotine addiction in many users of these devices.

The number of 12th graders who vape because they say they are “hooked” more than doubled between 2018 and 2019, from 3.6 percent to 8.1 percent. Addiction to nicotine could lead some users to switch to conventional cigarettes—a trajectory already found in some studies. Another noteworthy statistic in the MTF findings is that teens’ second most cited reason for vaping was liking the taste—a strong argument in favor of limiting the flavorings in vape products as a way of limiting these products’ tremendous appeal.

Apart from the real concerns linked to marijuana and nicotine vaping, the general picture painted by the MTF survey continues to be largely encouraging, however. Most illicit drug use continues to decline or hold steady at low levels. Cocaine and methamphetamine use are as low as they have ever been despite increases seen in adults. Nonmedical use of prescription opioids, which had raised worries several years ago in this survey, is also way down. And thankfully, the crisis of heroin use that continues unabated in U.S. adults also does not seem to be affecting high school students—heroin use continues to be very rare among teens surveyed, with past year use among high-school seniors at 0.4 percent. The fact that MTF is a survey of students in school is important to remember, however. It necessarily does not sample from those who have dropped out of school, and thus misses capturing a segment of the youth population for whom drug use is likely more prevalent.

See all the findings of the 2019 MTF survey, our press release, fact sheet and two infographics on vaping and other drug categories. For more information on the increases in marijuana vaping and what they mean, read the research letter published today in JAMA.

The MTF survey is a valuable indicator of substance use trends in the segment of the population most vulnerable to the short- and long-term effects of drug exposure. It is also the most “real-time” survey of drug use patterns: Every January, 42,531 students in 396 public and private schools across the nation take an hour or so to complete the MTF questionnaire—increasingly, on tablets rather than on paper—and the results are tabulated and analyzed by the end of that same year. It gives the NIDA-funded researchers at the University of Michigan, currently led by Richard A. Miech, an unprecedented ability to track substance use in real time.

Find Help Near You

The following website can help you find substance abuse or other mental health services in your area: www.samhsa.gov/find-treatment. If you are in an emergency situation, people at this toll-free, 24-hour hotline can help you get through this difficult time: 1-800-273-TALK. Or click on: www.suicidepreventionlifeline.org.

U.S. Surgeon General’s Advisory: Marijuana Use and the Developing Brain

Steven Barto, B.S., Psych.

I am reposting this information from a link to the U.S. Department of Health and Human Services (HHS.gov) provided by the National Institute on Drug Abuse (NIDA) website.

I, Surgeon General Jerome Adams, am emphasizing the importance of protecting our Nation from the health risks of marijuana use in adolescence and during pregnancy. Recent increases in access to marijuana and in its potency, along with misperceptions of safety of marijuana endanger our most precious resource, our nation’s youth.

Background

Marijuana, or cannabis, is the most commonly used illicit drug in the United States. It acts by binding to cannabinoid receptors in the brain to produce a variety of effects, including euphoria, intoxication, and memory and motor impairments. These same cannabinoid receptors are also critical for brain development. They are part of the endocannabinoid system, which impacts the formation of brain circuits important for decision making, mood and responding to stress.

Marijuana and its related products are widely available in multiple forms. These products can be eaten, drunk, smoked, and vaped. Marijuana contains varying levels of delta-9-tetrahydrocannabinol (THC), the component responsible for euphoria and intoxication, and cannabidiol (CBD). While CBD is not intoxicating and does not lead to addiction, its long-term effects are largely unknown, and most CBD products are untested and of uncertain purity.

Marijuana has changed over time. The marijuana available today is much stronger than previous versions. The THC concentration in commonly cultivated marijuana plants has increased three-fold between 1995 and 2014 (4% and 12% respectively). Marijuana available in dispensaries in some states has average concentrations of THC between 17.7% and 23.2%. Concentrated products, commonly known as dabs or waxes, are far more widely available to recreational users today and may contain between 23.7% and 75.9% THC.

The risks of physical dependence, addiction, and other negative consequences increase with exposure to high concentrations of THC and the younger the age of initiation. Higher doses of THC are more likely to produce anxiety, agitation, paranoia, and psychosis. Edible marijuana takes time to absorb and to produce its effects, increasing the risk of unintentional overdose, as well as accidental ingestion by children and adolescents. In addition, chronic users of marijuana with a high THC content are at risk for developing a condition known as cannabinoid hyperemesis syndrome, which is marked by severe cycles of nausea and vomiting.

This advisory is intended to raise awareness of the known and potential harms to developing brains, posed by the increasing availability of highly potent marijuana in multiple, concentrated forms. These harms are costly to individuals and to our society, impacting mental health and educational achievement and raising the risks of addiction and misuse of other substances.  Additionally, marijuana use remains illegal for youth under state law in all states; normalization of its use raises the potential for criminal consequences in this population. In addition to the health risks posed by marijuana use, sale or possession of marijuana remains illegal under federal law notwithstanding some state laws to the contrary.

Marijuana Use during Pregnancy

Pregnant women use marijuana more than any other illicit drug. In a national survey, marijuana use in the past month among pregnant women doubled (3.4% to 7%) between 2002 and 2017. In a study conducted in a large health system, marijuana use rose by 69% (4.2% to 7.1%) between 2009 and 2016 among pregnant women. Alarmingly, many retail dispensaries recommend marijuana to pregnant women for morning sickness.

Marijuana use during pregnancy can affect the developing fetus.

  • THC can enter the fetal brain from the mother’s bloodstream.
  • It may disrupt the endocannabinoid system, which is important for a healthy pregnancy and fetal brain development.
  • Studies have shown that marijuana use in pregnancy is associated with adverse outcomes, including lower birth weight.
  • The Colorado Pregnancy Risk Assessment Monitoring System reported that maternal marijuana use was associated with a 50% increased risk of low birth weight regardless of maternal age, race, ethnicity, education, and tobacco use.

The American College of Obstetricians and Gynecologists holds that “[w]omen who are pregnant or contemplating pregnancy should be encouraged to discontinue marijuana use. Women reporting marijuana use should be counseled about concerns regarding potential adverse health consequences of continued use during pregnancy”. In 2018, the American Academy of Pediatrics recommended that “…it is important to advise all adolescents and young women that if they become pregnant, marijuana should not be used during pregnancy.”

Maternal marijuana use may still be dangerous to the baby after birth. THC has been found in breast milk for up to six days after the last recorded use. It may affect the newborn’s brain development and result in hyperactivity, poor cognitive function, and other long-term consequences. Additionally, marijuana smoke contains many of the same harmful components as tobacco smoke. No one should smoke marijuana or tobacco around a baby.

Marijuana Use during Adolescence

Marijuana is also commonly used by adolescents, second only to alcohol. In 2017, approximately 9.2 million youth aged 12 to 25 reported marijuana use in the past month and 29% more young adults aged 18-25 started using marijuana. In addition, high school students’ perception of the harm from regular marijuana use has been steadily declining over the last decade. During this same period, a number of states have legalized adult use of marijuana for medicinal or recreational purposes, while it remains illegal under federal law. The legalization movement may be impacting youth perception of harm from marijuana. 

The human brain continues to develop from before birth into the mid-20s and is vulnerable to the effects of addictive substances. Frequent marijuana use during adolescence is associated with:

  • Changes in the areas of the brain involved in attention, memory, decision-making, and motivation. Deficits in attention and memory have been detected in marijuana-using teens even after a month of abstinence.
  • Impaired learning in adolescents. Chronic use is linked to declines in IQ, school performance that jeopardizes professional and social achievements, and life satisfaction.
  • Increased rates of school absence and drop-out, as well as suicide attempts.

Risk for and early onset of psychotic disorders, such as schizophrenia. The risk for psychotic disorders increases with frequency of use, potency of the marijuana product, and as the age at first use decreases. 

  • Other substance use. In 2017, teens 12-17 reporting frequent use of marijuana showed a 130% greater likelihood of misusing opioids.

Marijuana’s increasingly widespread availability in multiple and highly potent forms, coupled with a false and dangerous perception of safety among youth, merits a nationwide call to action. 

You Can Take Action

No amount of marijuana use during pregnancy or adolescence is known to be safe. Until and unless more is known about the long-term impact, the safest choice for pregnant women and adolescents is not to use marijuana.  Pregnant women and youth–and those who love them–need the facts and resources to support healthy decisions. It is critical to educate women and youth, as well as family members, school officials, state and local leaders, and health professionals, about the risks of marijuana, particularly as more states contemplate legalization.

Science-based messaging campaigns and targeted prevention programming are urgently needed to ensure that risks are clearly communicated and amplified by local, state, and national organizations. Clinicians can help by asking about marijuana use, informing mothers-to-be, new mothers, young people, and those vulnerable to psychotic disorders, of the risks. Clinicians can also prescribe safe, effective, and FDA-approved treatments for nausea, depression, and pain during pregnancy. Further research is needed to understand all the impacts of THC on the developing brain, but we know enough now to warrant concern and action. Everyone has a role in protecting our young people from the risks of marijuana.

Smoking “Wet”

Embalming Fluid-Soaked Marijuana

New High of New Guise for PCP?
By July Holland

The  trend of smoking marijuana soaked in embalming fluid is gaining popularity throughout the United States. The syndrome of intoxication looks nearly identical to that seen following phencyclidine (PCP) use, with agitation, disorganized speech and thoughts, and diminished attention. The author believes that this new trend in drug use involving marijuana also presents a resurgence in PCP use.

Several Case Reports

The first case involves a 28 year old African American male who arrived via ambulance to Bellevue ER for a psychiatric emergency. On admission, he was naked, disoriented to self, place and date, and was grossly psychotic. He referred to himself as “Allah,” “Justice,” and “Jesus.” Vital signs were normal. When asked if he had any drug allergies, the patient replied, “Yeah, wet.” The patient was alternately confused, then agitated, speaking of the coming of the Messiah. He appeared to be actively hallucinating, frequently looking over his shoulder or to his right as if he heard something.

After receiving 2 mg. of Ativan, the patient was able to state his name, and said that he had come on a bus from Philadelphia to Manhattan in order to make a rap album. He was grandiose about his connections to rap stars in New York City. He said he had disrobed on the bus in order to show the passengers that he was a “Native American,” and not a “mixed up American.” He was preoccupied with aliens, surveillance cameras, and robots. He also talked about twins and clones, referring to the “invasion of the double-mint twins.” He repeated paranoid ideation, stating that the Freemasons had a plot against him, and that the aliens had replaced his eye with a camera in order for him to transmit what he was seeing back to their spaceship. He said voices were telling him to “duck,” and to “look for the red spots.” He was easily distracted during the interview, and was sexually inappropriate with the interviewer.

The patient was re-evaluated the morning after he he was seen in the ER. His psychotic symptoms were gone. He was no longer delusional, was fully oriented, and was able to give personal medical history. He stated that every time he uses “wet” he has similar symptoms. He said, “I become hilarious. I can rhyme better. It makes me emotional, and I feel uncontrollably funny.” He described “wet” as being readily available in Philadelphia, where a small glasine envelope of tea leaves soaked in embalming fluid is sold for five dollars. He explained that he often mixes the leaves with marijuana. He said he was unaware that the tea leaves may contain PCP.

PCP and embalming fluid seem to be historically and semantically intertwined. The term “embalming fluid” was used to refer to PCP in the seventies, considered by some to be a marketing ploy. Embalming fluid has reportedly been used to cover the smell of PCP in order to evade drug-sniffing dogs. Many Internet postings mentioning “wet” or “dank” include the possibility that the fluid will contain PCP. The U.S. Department of Health and Human Services Marijuana Reality Check Kit, an online source of information about marijuana, warns of pot being spiked with other illicit drugs such as cocaine, crack, PCP and embalming fluid.

Workers at an adolescent drug treatment center in Olathe, Missouri estimated that 25% of  their patients had used “wet” (known locally as “dank”). Barbara Banks, assistant director of the facility, cited the low price and availability of “wet” and reported that “dank houses” were beginning to appear in the region. An intake interviewer and counselor for a drug treatment center in Angleton, Texas reports seeing tree patients whom he feels were permanently afflicted from the habit of smoking “wet.” He described short-term memory loss, lethargy, lack of motivation, and a decrease in spontaneous speech. He likened the syndrome to one he has seen due to long-term inhalant abuse.

A young man in Connecticut cut his wrists and drank floor stripper while intoxicated with “wet.” Driven by his psychosis, he reportedly had an urge to kill himself “before they get me.” Police felt the patient was acutely paranoid at the time of his arrest. Psychiatrists documented the patient as being agitated and delirious, and said he was having auditory, visual and tactile hallucinations at the time of his initial evaluation. Three days later, during his hospital stay, he was still exhibiting bizarre posturing, but was not quite catatonic. On the fourth day, he was noted to be euphoric, expansive and grandiose. He was giggling frequently, and showed poor judgment and was overly friendly. He offered cash to many staff members.

A 23 year old “wet” smoker in New York City described the high he achieved as feeling incapacitated, and referred to being “stuck.” He was afraid he was going to hurt himself and that others were out to hurt him. He heard a distant male voice calling his name. He knew where he was, but had no idea as to the time of day or the day of the week. He noted often forgetting what he was saying while speaking. He also said he would “lose time” while high. He admitted to being gay, and said he often had unprotected sex with other males while high. He said he would typically feel “out of control,” “horny,” and “elated.”

In summary, it is unclear whether the practice of smoking marijuana or tea leaves soaked in embalming fluid connotes a new type of intoxication, or whether what is currently being observed is PCP intoxication that simply has a new name or gimmick to aid in its allure and sales. More analysis of liquid samples purported to be embalming fluid would be helpful in answering this question. It is possible that there are long-term adverse effects from the practice of smoking “wet.” More reports need to be gathered. Obviously, this is a serious matter of public health. Clearly, intoxication with this drug severely clouds a person’s judgment. This is especially true regarding its effects on “safe sex” practices.

 

 

 

Driving After Marijuana Use

July 10, 2014

By Eric Sarlin, M.Ed., M.A.,
NIDA Notes Contributing Writer
National Institute on Drug Abuse
The Science of Drug Abuse & Addiction

Nearly 1 in 6 high school seniors who responded to a 2011 survey reported that, within the past 2 weeks, they had driven a motor vehicle after using an illicit drug or drinking heavily. Nearly 1 in 4 said they had recently ridden in a car with such a driver. Altogether 28% had put themselves at risk, within that short time frame, by being in a vehicle whose driver had been using marijuana or another illicit drug, or had consumed 5 or more alcoholic drinks. These rates had all risen nearly 20% in only 4 years, due almost entirely to an increase in driving after smoking marijuana.

The students’ responses also disclosed that, among 12th graders, driving after marijuana use has become more common than drinking and driving. About 1 in 8 (12.4%) reported that within the past 2 weeks they had driven after using marijuana, whereas 1 in 11 (8.7%) had driven after drinking alcohol. The prevalence of high school seniors driving after using marijuana had risen sharply from 10.4% in the 2008 iteration of the survey, while that of drinking and driving had declined from a peak of 16% in 2002. These changes parallel overall trends in students’ use of marijuana and alcohol.

Alcohol’s detrimental effects on road safety are well known, but it has been less clear whether marijuana produces similarly dangerous effects. Although the survey did not capture whether the teens were under the influence of alcohol or marijuana at the of any traffic incidents they reported being involved in, two of its findings underscore that marijuana use is associated with key indicators of dangerous driving. The high school seniors who drove after marijuana use and after heavy drinking were similarly likely to have had accidents (26.9% and 30.2%, respectively) and to have received traffic tickets or warnings (42.1% and 43.2 %, respectively) during the 12 months prior to taking the survey. The rates for these misadventures were about twice those of high school seniors who did not use these substances (16.3% for accidents; 20.2% for tickets or warnings).

Further analysis of the data revealed that 12th graders who were female, with two parents in the home, good grades, or strong religious commitments, were less likely to drive after using marijuana or alcohol. Those who reported above-average truancy, spent more evenings out for recreation, worked more hours, or drove more miles were more likely to engage in drugged driving.

African American students were more likely to drive after using marijuana than students of other races, but were not more likely to drive after drinking alcohol. Parental education, geographical region, and population density had no significant bearing on students’ attitudes toward drunk or drugged driving.

Vehicle accidents remain the number one cause of death among young Americans, and substance-impaired driving is one of the main culprits. Citing the data in their report, Dr. O’Malley and Dr. Johnston conclude that drunk and drugged driving is widespread among adolescents across schools and regions, and call for measures to reduce such risky behaviors.

Such efforts are already underway. A recent report prepared at NIDA’s request by experts in research, policy, and law enforcement under the auspices of the Institute for Behavior and Health has recommended to evaluate and improve drugged-driving laws, data collection, and educational programs, and to develop and standardize methods for drug testing in drivers. The goal of these proposed measures is to meet the target of the National Drug Control Strategy of the White House Office of National Drug Control Policy to reduce drugged driving by 10% by 2015.

Source

O’Malley, P.M.; Johnston, L.D. Driving after drug or alcohol use by U.S. high school seniors, 2001-2011. American Journal of Public Health 103(11): 2027-2034, 2013.

My Biggest Fear!

I have been a bundle of fears since I was a kid. I was convinced for a long time that there were monsters under my bed waiting to grab me by the foot when I got up to get a drink of water. My daddy gave me a flashlight one time on my birthday, but of course the batteries were always dead. I think I kept leaving it on all night under my covers. I just couldn’t handle all the creaking under my bed and the hollowing out my window. We had a lot of trees around our property, and on really windy nights long talons would dance around, reaching for me, trying to take me away.

It was really rough growing up. I was fat and not very good at sports. I usually ducked at a baseball pitch. I cringed whenever I played dodge ball. I couldn’t get the volleyball over the net. Badminton was just plain stupid. I was always last at track. And I never even considered trying out for football. I didn’t have a lot of friends in school. Yeah, a few, but they were like me, and we just ended up getting bullied together. It was a very painful way to go through school. One of my friends, Ronnie Benner, must have had enough. I don’t know the whole story, but one day he went up to the top of the Shikellamy Lookout over the Susquehanna River and jumped.

I managed to remain alive. I avoided most of the bullies. My plate quickly filled up with extra activities such as stringer photographer for high school sports, local radio station announcements, the yearbook staff, and a local history project. I used to hang out in the soundproof booth in the library and record DJ shows and radio plays. I was able to hide in away high school. Tucked away from all my enemies, whether they be fellow students, thugs who dropped out, or family. The worst thing that happened to me one day after school was being chased down by three bullies, one of which was Ron Mull. Ron’s sister, Lynn, was running with them at the time. The guys held me while Lynn beat the shit out of me. It was so humiliating for two reasons: first, a girl was beating me up, and, two, I had a crush on Lynn.

It didn’t take me long to discover marijuana and alcohol. I started hanging out with a whole new breed of friend. Ones who didn’t pick on me or chase me down the street threatening to kill me. These friends were handing me beers and joints and wanted to sit around and talk. We complained about bullies, and girls, and parents, and cops, and teachers, and having to work. We were convinced everyone was crooked and no one cared about the average kid on the street. We concluded it was our job to fight back. We took what we wanted. We skipped school. We threw rocks through the windows of abandoned warehouses and hunks of ice and snow at passing cars. We stood on railroad overpasses and pissed on vehicles going by. We were showing the world what’s what.

My alcohol consumption and pot use grew out of control. I knew I was using more than those around me. I just couldn’t get through a day without it. I took a hit when I got out of bed. I had bottles of Miller High Life stashed under rocks in cool running streams. Then there was grain alcohol and Vodka picked up for me by Russ, my “of age” best friend. He and I drank and smoked pot day and night. I think at one point my reality and my drugged fantasy got turned around, and I wasn’t sure what was real. It got so bad that I committed a series of felonies while high and got caught. Through a plea bargain, I was able to serve three years in a state prison, then seven years on state parole.

Unfortunately, my drug and alcohol use continued to be a problem. I was an addict and an alcoholic with no idea what to do about it. Days ran together. Weeks became months, and months became years. Nothing changed. I’ll quit tomorrow! But tomorrow never came. I lost cars and apartments and two wives. My youngest son stopped talking to me, despite having a baby. I’m a grandpa. I have yet to hold him. Little Skyler. The good thing is I came to realize all of these consequences and situations were my own doing. After a three-week stay at a drug and alcohol rehab, I signed on to the the idea that I am, all the way down to my toes, an alcoholic and a drug addict. I have accepted this as a fact in my life. And I have come to rely on Jesus Christ as my higher power. I have died with Him in His crucifixion, and I have been risen with Him to live again as a new creation.

My biggest fear is that I will one day return to the frame of mind where I feel justified to imbibe. To grab a joint and “relax.” You know, just one. A chance to let go and chill out. I just know where I’ve been, and I fully understand alcoholism and drug addiction. There is no safe situation in which I can use drugs or get drunk. I can only counter this fear by staying plugged in to the true definition of addiction, to remember what it has cost me in my life, and to realize that the only outcome to a lifetime of drug and alcohol addiction is death. And that is my biggest fear.

Is Marijuana a Safe Recreational Drug?

I started smoking marijuana at age eighteen immediately after graduating from high school. I did not drink or get high during my high school years. I did fairly well academically. I tested at an IQ of 127. I was very ambitious, outgoing, creative and focused. I wanted to be a published author, and also enjoyed photography and working in local radio broadcasting. My extracurricular activities included a local history project, sports photography and yearbook. I was on the debate team. I lettered in tennis in j-v. Having some issues with self-worth, and not liking confrontation, I stayed away from things like running for class president.

Marijuana has been in the news a lot lately. It seems every month a new state passes legislation that makes pot legal for medicinal purposes or, sometimes, for recreational use. Interestingly, the possession and sale of marijuana remains a federal crime. With all of this legislative activity, I can’t help but wonder if lawmakers are opening Pandora’s Box. Is marijuana a safe recreational drug? Can it lead to use of other substances? Is it addictive? How hard is it to quit smoking pot if you’ve been smoking it in large quantities or for a long time? Let’s start this discussion by talking about what pot is and what it does to those who use it.

Marijuana is the smokable part of the cannabis plant. It is usually sold in small plastic bags. When the drug comes from a medical marijuana facility, it may be packaged in a pill bottle or a vacuum-sealed package. When the resins of this plant are collected and compressed into blocks of dark brown material, that is called hashish. Most of the world hashish is made in Morocco. It is far stronger than marijuana. Hashish ranges from medium brown to almost black, and may have a sticky or crumbly consistency.

The dark, sticky oil of the resin or marijuana plant may also be sold in small bottles. This is called hash oil. It can be added to a marijuana cigarette to make it more potent, or it can be smoked in a pipe, a piece of aluminum foil or spoon. It can also be added to a tobacco cigarette to make it intoxicating. I smoked marijuana so heavily that when I ran out and needed to get high, I would scrape the pipe or bowl to scoop out concentrated amounts of resin. I would then smear the resin on cigarette paper and smoke it in the pipe. It was very potent, and I would sometime pass out from a big hit of the resin.

So let’s get right to the major question: Is marijuana addictive? Groups that are in favor of medical marijuana or broad legalization sweep this question under the carpet. The fact is that, yes, it is addictive. You are unlikely to hear this fact on the nightly news, in the newspaper or anywhere else. Marijuana is addictive. Of all the people that use marijuana, about one in eleven will become addicted. I was one of those who became addicted. When a young person begins smoking marijuana in his or her teens, that person has a one in six chance of becoming addicted. According to the Substance Abuse and Mental Health Services Administration, in 2010, more than 360,000 people were admitted to treatment for addiction, with marijuana being listed as the primary drug they were abusing. That is, they went into rehab because of marijuana and its effects on their bodies and minds. Twenty-eight percent, or approximately 103,000, were between twelve and seventeen years old. Forty-three percent were under twenty-one.

Because of greatly increased potency in marijuana, mental distress, panic attacks and other problems have also increased. In 2011, there were nearly half a million visits to the ER related to problems with marijuana use. Common symptoms were severe nausea, vomiting, high blood pressure, anxiety, panic attacks and paranoia. According to the 2013 World Drug Report, an estimated one in fifteen high school seniors is a daily or near-daily user of cannabis. For parents who used to smoke pot on the weekend or at parties, they can understand what daily use by a high school student would do to his ability to do his school work or to retain what he hears in a class lecture.

Some people argue that because marijuana does not have dramatic withdrawal symptoms like alcohol or heroin, it is not addictive. I see two errors with this thinking. One is that the pot being smoked today is far more potent than it was twenty or thirty years ago. That makes withdrawal a far different matter. Also, it is simply not true that quitting marijuana does not put you at risk for withdrawal. The most likely withdrawal symptoms include irritability, insomnia, anxiety, nightmares, anger and fluctuating emotions, headaches, depression, loss of appetite, and craving to use the drug. The degree to which the withdrawal symptoms are serious depends on how much pot the person was smoking, for how long they used the drug, and their own unique physical and emotional makeup.

I think a better measure of addiction is whether or not the person experiences harm from the use of the drug but is so compelled to use it and the cravings for it are so strong that he uses it anyway. This was true for me. I used marijuana in large amounts from the age of eighteen until the age of 48. My cravings were so strong that I used the drug despite failing health, difficulty making bill payments while buying the drug, inability to concentrate on the job as a paralegal, strained or broken interpersonal relationships, bounced checks, and an inability to sleep or relax without getting high. An addicted cannabis user will continue to get high despite the occurrence of these types of consequences. It is common for a heavy pot smoker to stop caring about the damage and just focus on staying stoned. This applies to heavy marijuana use, as well as crack cocaine or meth or pain pills.

Marijuana is not the harmless, safe substance many might like to think it is, especially for those under age thirty. According to some of the Internet research I conducted, neuroscience has now shown us that the brain continues to develop until the late 20s, and using drugs while the brain is still developing can influence how it develops and result in moderate to potentially significant problems down the line. When adolescents use marijuana, for example, the white matter of their brains can undergo changes that are similar to the brains of individuals with schizophrenia. Perhaps it’s not surprising, then, that marijuana smoking in adolescence significantly increases the risk for eventually becoming psychotic and/or developing schizophrenia. This risk is even greater for people who had psychiatric symptoms before their first experience with marijuana and those with schizophrenia in their families. And furthermore, more and more data are confirming the fact that marijuana users are also at increased risk for developing anxiety and depression later in their lives, as well as having memory deficits.

All of this proved true in my own life. I had no idea I was suffering from an underlying psychiatric problem. I didn’t know I had bipolar disorder, anxiety disorder, and major depression. The constant use of alcohol and marijuana kept the symptoms hidden. As you’ve probably heard it said, I was self-medicating. Marijuana masked some of my difficulties, and distracted me enough that I didn’t understand what was going on. Not only did my psychiatric problems increase, my cravings for pot greatly increased. I knew no other life. It had become perfectly normal for me to be high. Anything else seemed abnormal. So when I hear people say marijuana is perfectly safe, I strongly disagree. I know what it did to me over the years, and I’ve seen it do the same thing to others. I went to my five-year high school reunion. I ran into people I used to get high with. You probably won’t be shocked to learn that they had not grown in any significant manner, and were still smoking pot.

Back when I went to high school in the mid 1970s, about thirty percent of the students I knew were using marijuana regularly. They called it “partying” or “getting stoned.” It wasn’t hard to recognize when someone started using pot. Almost instantly, their overall attitude changed. Many who had been good students, engaged and talented, started to withdraw, and adopt a passive aggressive viewpoint. Regular pot use by them, from what I observed, caused a kind of lethargy. Activity levels dropped off drastically. They developed a “who cares” attitude, and became non-compliant. The look on the face of most pot users is sort of vacant and dull. Their eyes glaze over and don’t seem to focus. If you’re not also high, conversation with them is particularly difficult.

Typically, marijuana users tend to believe pot is harmless. That there are far more dangerous drugs they could be using. In fact, pot is “all natural,” so it must be okay. Pot users do not see the gradual increase in tolerance and a need for smoking more and more. Once a pot smoker is convinced he or she cannot live without marijuana, this is addiction. When the person uses even though he or she promised themselves they wouldn’t, this is compulsion. It is the nature of addiction that addicts don’t believe they are ill. They do not have a problem. Addiction is a physical, mental and spiritual disease. It doesn’t matter what the substance is.

I remember years ago realizing I was getting high too often, and I told my “dealer” I might need to go to rehab. He laughed, saying I would be bullied in the facility for merely being a marijuana user. I told him I was having a very difficult time stopping, that I was spending all my money on pot, that my interpersonal relationships were suffering, and that I was a wreck when I wasn’t high. This was a sure sign of addiction and compulsion. Not only was I psychologically dependent on pot, I had also become an alcoholic, drinking nearly a fifth of Vodka per day. My behavior became so antisocial that I ended up serving a three year sentence in state prison. It is definitely my opinion, based upon research and my personal experience, that chronic pot smoking leads to many problems. It is not simply a harmless “natural” recreational drug. It has the potential to create emotional, physical and financial problems, and often leads to using other substances once smoking pot becomes boring or doesn’t do the trick anymore. Marijuana is not a safe recreational drug.