Top Ten for 2010

Marijuana leads the list.

Most viewed Addiction Inbox 2010 blog posts, ranked by total pageviews:


1. Marijuana and Memory: Do certain strains make you more forgetful?

“Cannabis snobs have been known to argue endlessly about the quality of the highs produced by their favorite varietals: Northern Lights, Hawaiian Haze, White Widow, etc….”

2.  The Bong Water Case Revisited: Minnesota v. Peck.

“Astute readers will recall the Great Bong Water Decision of 2009, in which the Minnesota Supreme Court determined, 4-3, that water used in a water pipe can be considered a ‘drug mixture’….”

3. Cannabis Receptors and the “Runner’s High”--Maybe it isn't endorphins after all.

“What do long-distance running and marijuana smoking have in common? Quite possibly, more than you’d think. A growing body of research suggests that the runner’s high and the cannabis high are more similar than previously imagined….”

4. More Vanishing Cigarettes: Churchill, Bette Davis, Don Draper, and Pecos Bill.

“In my last post, I highlighted some examples of attacks on cultural history represented by cigarette censorship, to wit: a cigarette taken out of the hand of Paul McCartney, and out of the mouths of Jackson Pollock and Burt Reynolds.…”

5. Cocaine Treatment and the Stroop Test: Treatment dropouts do poorly on color/word match.

“It’s commonly used to demonstrate behavioral inhibition, but it’s also a nifty parlor game. It is called the Stroop Test, and it plays off the fact that people are far better at reading words than they are at intentionally ignoring them….”

6. Liking it Vs. Wanting it: The joylessness of drug addiction.

“Hedonism, the pursuit of pleasure for its own sake, is not really the answer to the riddle of drug addiction. The pursuit of pleasure does not explain why so many addicts insist that they abuse drugs in a never-ending attempt to feel normal….”

7. Mephedrone, the New Drug in Town: Bull market for quasi-legal designer highs.

“Most people in the United States have never heard of it. Very few have ever tried it. But if Europe is any kind of leading indicator for synthetic drugs (and it is), then America will shortly have a chance to get acquainted with mephedrone….”

8. Sex, Drugs, and… Sex: Pharmaceuticals and sexual performance.

“The search for aphrodisiacs is an ancient, if not always venerable, human pursuit. Named for Aphrodite, the Greek goddess of love, aphrodisiacs are compounds that have the reputation, real or imagined, of increasing sexual desire, pleasure, and potency….”

9. Meth Babies—Fact or Fiction? Research team finds brain abnormalities.

“When it came to babies born to crack-addicted mothers, the media went overboard, creating a crisis in the form of an epidemic that never quite was. By contrast, when it came to babies born to alcoholic mothers, Fetal Alcohol Syndrome went unrecognized in the science and medical community until 1968….”

10. Marijuana Use Up, Up, Up: NIDA releases annual survey of teen drug use.

“Research compiled from an annual survey of 8th, 10th and 12th graders by the National Institute on Drug Abuse (NIDA) shows that “marijuana use increased among eighth-graders, and daily marijuana use increased significantly among all three grades….”

Graphics Credit: http://www.thoughttheater.com/

Science Books for Christmas

Women and children first.

It’s not my fault that some of the best science books of 2010 were written by women. In fact, I’m just going to say it: All of the best science books of the year were written by women. Here are a few candidates.

--Rebecca Skloot, The Immortal Life of Henrietta Lacks 

Publishers Weekly: “A tale of medical wonders and medical arrogance, racism, poverty and the bond that grows, sometimes painfully, between two very different women—Skloot and Deborah Lacks—sharing an obsession to learn about Deborah's mother, Henrietta, and her magical, immortal cells.”

--Mary Roach, Packing for Mars: The Curious Science of Life in the Void

Publishers Weekly: “Roach (Stiff) once again proves herself the ideal guide to a parallel universe. Despite all the high-tech science that has resulted in space shuttles and moonwalks, the most crippling hurdles of cosmic travel are our most primordial human qualities: eating, going to the bathroom, having sex and bathing, and not dying in reentry.”

--Mia Szalavitz, Born for Love: Why Empathy is Essential and Endangered 

Product Description: “An inside look at the power of empathy: Born for Love is an unprecedented exploration of how and why the brain learns to bond with others—and a stirring call to protect our children from new threats to their capacity to love.”

--Deborah Blum, The Poisoners Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York

Publishers Weekly: “Pulitzer Prize–winning science journalist Blum (Ghost Hunters) makes chemistry come alive in her enthralling account of two forensic pioneers in early 20th-century New York. Blum follows the often unglamorous but monumentally important careers of Dr. Charles Norris, Manhattan's first trained chief medical examiner, and Alexander Gettler, its first toxicologist.”

--Jennifer Ouellette, The Calculus Diaries: How math can help you lose weight, win in Vegas, and Survive a Zombie Apocalypse

Nature: "In The Calculus Diaries, science writer Jennifer Ouellette makes maths palatable using a mix of humour, anecdote and enticing facts...Using everyday examples, such as petrol mileage and fairground rides, Ouellette makes even complex ideas such as calculus and probability appealing."

--Susan Casey, The Wave: In Pursuit of the Rogues, Freaks and Giants of the Ocean

Bookmarks Magazine: “Part science lesson and part adrenaline rush, The Wave is an intense thrill ride that manages to take a broad look at oversized, potentially devastating waves. The critics praised Casey's eloquent writing and jaw-droppingly vivid descriptions of chasing--or trying desperately to steer clear of--these aquatic behemoths.”

And:

Smithsonian science books for kids.

Graphics Credit: http://www.zoology.ubc.ca/

Marijuana Use Up, Up, Up

NIDA releases annual survey of teen drug use.

Research compiled from an annual survey of 8th, 10th and 12th graders by the National Institute on Drug Abuse (NIDA) shows that “marijuana use increased among eighth-graders, and daily marijuana use increased significantly among all three grades. The 2010 use rates were 6.1 percent of high school seniors, 3.3 percent of 10th -graders, and 1.2 percent of eighth-graders compared to 2009 rates of 5.2 percent, 2.8 percent, and 1.0 percent, respectively.”

At a news conference held to announce the results of the study, NIDA director Dr. Nora Volkow said that “high rates of marijuana use during the teen and pre-teen years, when the brain continues to develop, place our young people at particular risk. Not only does marijuana affect learning, judgment, and motor skills, but research tells us that about 1 in 6 people who start using it as adolescents become addicted.”

The annual report, called “Monitoring the Future,” takes the temperature of current teen drug use through interviews with more than 50,000 students across the country. The research is conducted at the Survey Research Center in the Institute for Social Research at the University of Michigan.

The survey showed that teen use of Ecstasy is on the increase as well. According to NIDA, “The MTF survey also showed a significant increase in the reported use of MDMA, or Ecstasy, with 2.4 percent of eighth-graders citing past-year use, compared to 1.3 percent in 2009. Similarly, past-year MDMA use among 10th-graders increased from 3.7 percent to 4.7 percent in 2010.”

As for cigarettes, the recent downward trend has “stalled” after several years of steady improvement, said NIDA. “Greater marketing of other forms of tobacco prompted the 2010 survey to add measures for 12th-graders’ use of small cigars (23.1 percent) and of tobacco with a smoking pipe known as a hookah (17.1 percent).”

For the first time, according to the survey, “declines in cigarette use accompanied by recent increases in marijuana use have put marijuana ahead of cigarette smoking by some measures. In 2010, 21.4 percent of high school seniors used marijuana in the past 30 days, while 19.2 percent smoked cigarettes.”

The survey detected a downward trend in binge drinking across the board. Prescription drug abuse remained fairly steady.

The survey also tracks students’ perception of drugs and their risks, and the degree to which drug are viewed as harmful. The report concludes: “Related to its increased use, the perception that regular marijuana smoking is harmful decreased for 10th- graders (down from 59.5 percent in 2009 to 57.2 percent in 2010) and 12th-graders (from 52.4 percent in 2009 to 46.8 percent in 2010). Moreover, disapproval of smoking marijuana decreased significantly among eighth-graders.”

The survey at the University of Michigan is led by Dr. Lloyd Johnston, operating under a NIDA grant. Additional information on the MTF Survey, as well as comments from Dr. Volkow can be found at http://www.drugabuse.gov/drugpages/MTF.html.

Era of the Electronic Cigarette Officially Begins.

Court blocks FDA from prohibiting e-cigarettes.

It’s official: The e-cigarette is here. The right of a distributor of Chinese electronic cigarettes to market the product in the U.S. was solidly affirmed last week by a three-judge ruling in the U.S. Court of Appeals for the District of Columbia. The Food and Drug Administration’s refusal last year to allow importation of e-cigarettes by Sottera Inc. had been the basis for a lower court decision in Sottera’s favor. The earlier court ruled that e-cigarettes did not require FDA approval because they were neither new drugs nor new drug delivery devices. (The FDA is prohibited by an act of Congress from barring the sale of tobacco products outright.)

Last month, under a consent judgement worked out with California state Attorney General Jerry Brown in a related case, Florida-based Smoking Everywhere Co., another distributor of Chinese electronic cigarettes, had agreed not to target minors in its advertising, or to make claims that its products are safe alternatives to tobacco. The move came shortly after the FDA announced plans to regulated battery-powered e-cigarettes as new drug delivery devices, culminating in the Sottera lawsuit.

The legal argument before the appeals court hinged largely on semantics. The court found that electronic cigarettes are “battery-powered products that allow users to inhale nicotine vapor without fire, smoke, ash or carbon monoxide. The liquid nicotine is derived from natural tobacco plants.”

Here is the catch: “The FDA may only approve a product for marketing under the Federal Food, Drug and Cosmetic Act (FDCA) if it is safe and effective for its intended use,” the Appeals Court Justices ruled.  However, the FDA has “exhaustively documented” that tobacco products are unsafe for pharmacological use of any kind. The earlier court had concluded, stealing a page from “Alice in Wonderland”: “If they cannot be used safely for any therapeutic purpose, and yet they cannot be banned, they simply do not fit” within any conceivable regulatory scheme.

Hence the difficulties in the FDA’s attempt to regulate by agency fiat. E-cigarette manufacturers and distributors, having sensed an opening, are now ready to drive a convoy of semis right through it. This wasn’t a completely straightforward march, as the e-cigarette forces, in the appeals presentation, were required to thread the needle on such conundrums as: Does it matter that e-cigarettes do not, strictly speaking, contain “tobacco products?” Nicotine is a component of, not a product of, tobacco.

You see the problem. The relevant statutes have not been written with pure nicotine delivery devices in mind. In fact, having nicotine--but not the evil substance tobacco--in your product turned out to be a definitional advantage for the e-cigarette marketers: The court pointed out that, unlike products containing tobacco, which the FDA has found to be associated with “cancer, respiratory illnesses, and heart disease,” the FDA has manifestly NOT found that nicotine or tobacco-free products that deliver nicotine are inherently unsafe. And second, the “tobacco-specific legislation” invoked in earlier court cases “simply does not address products that deliver nicotine but contain no tobacco.”

Matthew Myers, president of the Campaign for Tobacco-Free Kids, said in a prepared statement: "This decision will allow any manufacturer to put any level of nicotine in any product and sell it to anybody, including children, with no government regulation or oversight at the present time. We urge the government to appeal this ruling."

Among the many  questions the ruling leaves open is the status of e-cigarettes under existing no-smoking regulations. That litigation has not even gotten underway.

See my earlier post on the e-cigarette question HERE.

For the full court decision, click HERE.

Graphics Credit:  http://thestrobel3.blogspot.com/

Cannabis and Severe Vomiting

Pot can make you puke.

For those of you who missed this, as I did, here is a belated account of a rare but altogether curious side effect of heavy marijuana use: cyclical vomiting.

Nice, eh? And yes, it goes completely against the grain of what we think we know about marijuana: Ironically, cannabis is frequently employed to prevent the nausea and vomiting frequently associated with chemotherapy.

So what gives? The answer is that, so far, nobody really knows.

First things first: It appears to be a very rare side effect of regular marijuana use, and it was not documented in the medical literature until 2004. Given the long history of pot-smoking the world over, it is reasonable to ask where the cannabis emesis syndrome has been hiding all these years.  A fair question, but one which, at this stage, has no satisfying answer.

Cannabinoid hyperemesis, as it's known, was first brought to wider attention earlier this year by the anonymous biomedical researcher who calls himself Drugmonkey. Posting on his eponymous blog, Drugmonkey documented cases of hyperemesis that had been reported in Australia and New Zealand, as well as Omaha and Boston in the U.S.

"There were two striking similarities across all these cases," Drugmonkey reported. "The first is that patients had discovered on their own that taking a hot bath or shower alleviated their symptoms. So afflicted individuals were taking multiple hot showers or baths per day to obtain symptom relief. The second similarity is, as you will have guessed, they were all cannabis users."

Heavy, regular cannabis users, most of them. And hot baths? Where did THAT come from?

More evidence was not long in coming. In February, researchers in the Division of Gastroenterology at William Beaumont Hospital in Royal Oak, Michigan, identified eight patients in their gastroenterology wards who were suffering from "otherwise unexplained refractory, recurrent vomiting." As the researchers reported in the journal Digestive Diseases and Sciences, there were two other significant features the eight patients shared: They were all chronic cannabis smokers--and they were all compulsive bathers.

The connection between uncontrolled vomiting and heavy toking seemed unequivocal: "Four out of five patients who discontinued cannabis use recovered from the syndrome," according to the published report, "while the other three patients who continued cannabis use, despite recommendations for cessation, continued to have this syndrome."

There is precious little anecdotal evidence to support this surprising finding. Occasionally, naive marijuana smokers will ingest too much and become sick to their stomach. And it is possible to incur the (brief) wrath of cyclic vomiting by eating way too many marijuana brownies, or other cannabis foodstuffs. Short of that, I am not familiar with vomiting as a documented side effect of regular cannabis use, and I venture to guess that most readers aren't, either.

However, the reports haven't stopped. This summer, an intriguing account appeared in Clinical Correlations, the official blog of New York University's Division of General Internal Medicine. Sarah A. Buckley and Nicholas M. Mark, 4th year medical students at the NYU School of Medicine, speculated on the cannabis hyperemesis phenomenon, and offered a formal definition: "A clinical syndrome characterized by intractable vomiting and abdominal pain associated with the unusual learned behavior of compulsive hot water bathing, occurring in the setting of long-term heavy marijuana use."

After reviewing 16 published papers on the syndrome, Buckley and Mark asked the obvious question: "How can marijuana, which is used in cancer clinics as an anti-emetic, cause intractable vomiting? And why would symptoms abate in response to high temperature?"

One possible mechanism involves marijuana's penchant for fats. Theoretically, this "lipophilicity" could cause increasingly toxic concentrations of THC over time, in susceptible people. "The abdominal pain and vomiting are explained by the effect of cannabinoids on CB-1 receptors in the intestinal nerve plexus," they write, "causing relaxation of the lower esophageal sphincter and inhibition of gastrointestinal motility." The authors speculate that low doses of THC might be anti-emetic, whereas in certain people, the high concentrations produced by long-term use could have the opposite effect.

As for the hot baths, Buckley and Mark note that "cannabis disrupts autonomic and thermoregulatory functions of the hippocampal-hypothalamic-pituitary system," which is loaded with CB-1 receptors. The researchers conclude, however, that the link between marijuana and thermoregulation "does not provide a causal relationship" for what they refer to as "this bizarre learned behavior."

These questions, like many questions having to do with regular marijuana use, are not likely to be answered definitively anytime soon, for a number of good reasons, some of which are delineated by the authors:

--"The legal status of marijuana makes eliciting an accurate drug history challenging."

--"The bizarre hot water bathing is likely often attributed to psychological conditions such as obsessive-compulsive behavior."

--"The knowledge of the anti-emetic effects of cannabis likely disguise cases of cannabinoid hyperemesis, leading to the erroneous belief that cannabis is treating cyclic vomiting rather than causing it."

--"The fact that this syndrome is so recently described and relatively unknown outside an esoteric subset of the GI [gastrointestinal] literature means that most clinicians are unaware of its existence."

Graphics Credit: http://www.oxygentimerelease.com/

MAPS Sponsors Psychedelic Confab

And J.R. will discuss his LSD trips with you.

The Multidisciplinary Association of Psychedelic Studies (MAPS) has put together a roster of very big psychedelic guns, as well as a few surprises, for its mini-conference on December 12-13 in Los Angeles. On tap for the convocation are such luminaries as Stanislav Grof of Holotropic Breathwork fame; as well as Charles Grob, professor of Psychiatry and Pediatrics at the UCLA School of Medicine and a psychedelic research of long standing who recently studied the effects of psilocybin on death anxiety in terminal cancer patients.

“Catalysts: The Impact of Psychedelics from Consciousness to the Clinic, and from Culture to Creativity” will feature presentations and discussions on “psychedelic science, the current state of psychedelic research, and clinical applications for therapeutic use.”

Other experts among the scientists, physicians, psychologists, writers, and artists expected to attend include Rick Doblin, the founder of MAPS, who has specialized in research on MDMA (Ecstasy) as a treatment for posttraumatic stress disorder. Another scheduled attendee, James Fadiman, was introduced to the field of psychedelic drugs by his Harvard undergraduate advisor Richard Alpert, who later became well known as Baba Ram Dass. Fadiman holds the distinction of being the last LSD researcher to be shut down by the U.S. government, when he was at San Francisco State University in 1972.

Also in attendance will be Julie Holland, an assistant professor of psychiatry at NYU School of Medicine, and the author of “Ecstasy: A Complete Guide,” and Clare Wilkins, director of the Pangea Biomedics Ibogaine Clinic in Mexico.

Special Bonus Appearance:

I can’t imagine that anyone under the age of 55 is likely to know who Larry Hagman is. Long ago, he was on a camp TV show about a Texas oil bazillionaire with nasty habits. Not only was he a big TV star, he was also old enough to have been around when LSD psychotherapy came to the couches of Hollywood analysts for a brief period in the 1960s and attracted some other odd ducks like Cary Grant and James Coburn. Hagman, Star of TV’s “Dallas” and “I Dream of Jeannie,” will discuss his experiences with LSD psychotherapy.

Earlier, he talked about his experiences in a 2003 interview with Rick Doblin, published in the MAPS journal and excerpted below:

Before I tried LSD, I'd been going to a psychologist for a couple of years…. I had been addicted to tobacco and Bontril, a mild form of amphetamine, doctor-prescribed of course….

I was backstage at a performance one time with Crosby, Stills & Nash and I was talking about it to David Crosby. David said, well, shit, man, here. He handed me a handful of little pills. I said what the fuck? He says this is LSD. It was the best going around at that time. This was before Blue Cheer and Windowpane. This was the original Owsley. He gave me about 25 pills. I said, well, how much should I take? He says, well, don't take more than one….

… my first acid trip was the most illuminating experience of my life. I would highly recommend it for people who study and prepare for it and who are not neurotic or psychotic. I don't know what it would do to psychotic people. I know what it does to neurotic people who can't handle that. They get terrified and do crazy things like jumping out of windows and stuff like that. That's happened to a couple of friends of mine.

Graphics Credit: http://en.wikipedia.org/wiki/Larry_Hagman

World AIDS Day

Testing, Testing.

Guest Post By Kevin Fenton, M.D., Ph.D., FFPH, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC). 

Every year on December 1, we commemorate World AIDS Day to bring attention to the tremendous impact of the HIV epidemic in the United States and around the world. In observance of World AIDS Day, today CDC launched a special report, CDC Vital Signs on HIV Testing in the United States, in recognition of the pivotal role that HIV testing plays in our national HIV prevention strategy.

Some highlights of the CDC Vital Signs report on HIV testing include:

    •    In 2009, an estimated 82.9 million Americans ages 18-64—45% of this age group—reported they had been tested for HIV.

    •    At least 1 in 3 Americans who test positive for HIV is tested too late in his or her infection to get the full advantage of life-saving treatment.

    •    Gay, bisexual, or other men who have sex with men have the highest rates of HIV, but a 2008 study conducted in 21 major US cities, found that about 40% had not been tested in the past year.

    •   African Americans made up more than half of HIV diagnoses in 2008, but 2 in 5 African Americans have never been tested.

CDC recommended in 2006 that HIV testing become a routine part of medical care, including testing of all adolescents and adults at least once, testing at least annually for persons at increased risk, and testing of women during each pregnancy. Since that time, HIV testing has increased, and more people are being tested for HIV than ever before. However, many challenges remain: 55% of Americans ages 18 to 64 still have never been tested, according to CDC Vital Signs. And of the estimated 1.1 million people living with HIV in the United States, 1 in 5 do not know they are infected.

More needs to be done. HIV testing is vitally important because it can save lives. For anyone who is infected, it is important to know his or her HIV status in order to access effective life-extending treatment, avoid HIV transmission to partners, and have a better quality of life.

Treatment for HIV is most effective before symptoms develop. It can do much to slow the infection that leads to AIDS and death. Without treatment a person infected with HIV will develop AIDS in about 10 years. With early treatment a 25-year-old adult can survive on average 39 more years.

According to the Vital Signs report, nearly one-third (32%) of the people found with HIV in 2007 were diagnosed late. This means that they likely had HIV for a long time without knowing it because they developed AIDS soon (less than one year) after their HIV test.

Health care providers play a critical role in stopping the spread of HIV as most HIV testing is conducted in health care settings. It is important that patients listen to their doctors and it is important that doctors and other health care providers speak openly and honestly with patients about HIV, and offer routine testing per CDC recommendations.

CDC also plays a critical role. We are committed to strengthening our efforts against the epidemic and working with partners to increase HIV testing. CDC continues to expand its efforts in areas where the burden of disease is greatest. We recently announced an expansion of a successful HIV testing initiative to reach more hard-hit populations, including African Americans, Latinos, men who have sex with men and injection drug users. In 2010, CDC provided more than $60 million to support HIV testing efforts in 30 of the hardest hit jurisdictions in the United States.

In addition, CDC provides funds to all health departments and more than 130 community-based organizations to implement HIV prevention programs, including HIV testing. We are also working to get messages out about testing through the Act Against AIDS  campaign. Of critical importance, the National HIV/AIDS Strategy, recently released by the White House, provides a new opportunity to refocus and intensify federal, state, and local HIV testing efforts.

Now more than ever, effective HIV prevention is a critical public health priority for the U.S. and the world, and HIV testing to identify those infected is a vital component of that effort. Working together, we can increase HIV testing. Everyone needs to know how important HIV testing is – it is a simple measure that can literally save the health and lives of hundreds of thousands of Americans and help to bring an end to this tragic epidemic.

Challenging the Received Wisdom on Tobacco Addiction

What does it take to get hooked on nicotine?

--Smokers who smoke five or fewer cigarettes per day can still become addicted to tobacco.

--Tobacco addiction can also be present in non-daily smokers.

--Nicotine withdrawal symptoms do not necessarily begin within 24 hours.

These and other controversial assertions come from Joseph R DiFranza, a physician with the Department of Family Medicine and Community Health at the University of Massachusetts Medical School. Dr. DiFranza recently authored a provocative examination of smoking truisms in an article for the online publication Harm Reduction Journal.

In an attack on what he calls the Threshold Model of Addiction, DiFranza defines the model as follows:

In brief, the threshold model maintains that until tobacco consumption is maintained above a threshold of 5-10 cigarettes per day (cpd) for a prolonged period, smokers are free of all symptoms of tobacco addiction. It holds that declining blood nicotine levels trigger withdrawal symptoms so quickly that addicted smokers must protect their nicotine levels by smoking at least 5 cpd. The threshold model states that until addiction is established with moderate daily smoking, smoking is motivated and maintained by peer pressure, pleasure seeking and the social rewards of smoking.

DiFranza breaks this prevailing paradigm into a half-dozen hypotheses, offering his opinion on the state of scientific evidence that, in his view, refutes every one of them:

--Hypothesis 1. Tobacco addiction cannot occur in nondaily smokers, or even in daily smokers who regularly consume fewer than 5 cpd.

DiFranza’s response:   “Although it is difficult to prove a negative, this hypothesis would be supported if study after study demonstrated that all surveyed subthreshold smokers (individuals who smoke < 5 cpd) have no symptoms of addiction…. Since no studies have demonstrated a complete lack of addiction symptoms in any representative population of subthreshold smokers, the peer reviewed literature soundly refutes the hypothesis that tobacco addiction requires as a prerequisite the daily consumption of 5-10 cigarettes. The threshold model and the DSM are wrong. “

--Hypothesis 2. Tobacco addiction requires prolonged daily use as a prerequisite.

Response: “Many subjects developed symptoms quite soon after the onset of intermittent tobacco use. These findings have been replicated in several longitudinal studies, in cross-sectional studies showing symptoms of addiction in nondaily smokers, and by case histories showing the same.”

Hypothesis 3. Nicotine withdrawal symptoms begin within 24 hours in all smokers.

“The standard subject in all early smoking studies was an adult who had been a heavy daily smoker for decades. Such individuals do experience nicotine withdrawal soon after their last cigarette. A problem arises when this observation is inappropriately generalized by applying it to all smokers, including children, novices and nondaily smokers.”

Hypothesis 4. Addicted smokers must maintain nicotine above a threshold blood concentration to avoid withdrawal.

“Since a person must smoke at least 5 cpd to maintain a minimum nicotine level throughout the day, another approach to testing this hypothesis would be to determine if all smokers that experience withdrawal symptoms smoke at least 5 cpd. This test has been completed over a dozen times, and always with the same result. Withdrawal symptoms have been reported in smokers of fewer than 5 cpd in every study that has examined this issue.”

Hypothesis 5. Psychosocial factors maintain smoking over the several years it may take to reach threshold levels of smoking.

“There must be thousands of studies that demonstrate that social factors such as socioeconomic status, smoking by family and friends, cigarette advertising, the availability of cigarettes, smoking depictions in movies, and attitudes and beliefs are predictive of which youth will try smoking. However, if such factors sustain tobacco use until tobacco addiction develops, they should predict which smokers will advance to addiction in prospective studies. But this has not been shown. None of more than 40 psychosocial risk factors for the onset of smoking was able to predict the progression to tobacco addiction. The author is aware of no studies that establish that peer pressure of other social factors sustain adolescent or young adult smoking over the 4 or 5 years it may take for smokers to reach threshold levels of smoking. “

Hypothesis 6. Increasing tolerance to the pleasurable effects of smoking drives the escalation in tobacco use up to the threshold of addiction.

“The author is not aware of any studies that demonstrate that smokers must smoke more cigarettes over time to obtain the same amount of pleasure (for example smoking 10 cpd to obtain the same pleasure initially obtained from smoking 1 cpd. Indeed, our data indicate that the pleasure obtained from smoking each cigarette actually increases in proportion to the degree of addiction, with pleasure ratings correlating strongly with addiction severity. While this is only one study, it directly contradicts the hypothesis that non-addicted novice smokers obtain much more pleasure from each cigarette than do addicted heavy smokers.”

Photo Credit: http://nikotin.floridadmat.com/

DEA Slaps Temporary Ban on Spice and Other “Fake Pot” Products

Synthetic cannabis now illegal for one year.

The material below is excerpted directly from the official press release of the U.S Drug Enforcement Administration Public Affairs Office:

The United States Drug Enforcement Administration (DEA) is using its emergency scheduling authority to temporarily control five chemicals (JWH-018, JWH-073, JWH-200, CP-47,497, and cannabicyclohexanol) used to make “fake pot” products.  Except as authorized by law, this action will make possessing and selling these chemicals or the products that contain them illegal in the U.S. for at least one year while the DEA and the United States Department of Health and Human Services (DHHS) further study whether these chemicals and products should be permanently controlled. 

A Notice of Intent to Temporarily Control was published in the Federal Register today to alert the public to this action. After no fewer than 30 days, DEA will publish in the Federal Register a Final Rule to Temporarily Control these chemicals for at least 12 months with the possibility of a six-month extension. They will be designated as Schedule I substances, the most restrictive category, which is reserved for unsafe, highly abused substances with no medical usage.

Over the past year, smokable herbal blends marketed as being “legal” and providing a marijuana-like high, have become increasingly popular, particularly among teens and young adults.  These products consist of plant material that has been coated with research chemicals that mimic THC, the active ingredient in marijuana, and are sold at a variety of retail outlets, in head shops and over the Internet.  These chemicals, however, have not been approved by the FDA for human consumption and there is no oversight of the manufacturing process.  Brands such as “Spice,” “K2,” “Blaze,” and “Red X Dawn” are labeled as incense to mask their intended purpose.

Graphics Credit: http://thefreshscent.com/

Drug-Drug Interactions to Watch Out For

P450 enzymes and “poor metabolizers.”

The finding, published in Science, is a bit arcane to the layperson. The big secret of how the P450 enzyme family metabolizes drugs turns out to be a critical phase change, where an oxygen molecule temporarily joins the mix, forming “Compound I,” a process the scientists documented by cooling the enzymes at just the right rate. 

So what? Well, for starters, “cytochrome P450 enzymes are responsible for the phase I metabolism of approximately 75% of known pharmaceuticals,” write Jonathan Rittle and Michael T. Green at Pennsylvania State University’s Department of Chemistry.  And in fact, only six of the more than 50 enzymes in the P450 family account for 90% of drug metabolization in humans--the compound known as CYP2D6 being the most crucial.

In a Penn State press release, lead author Michael Green, an associate professor of chemistry, noted that human populations vary widely in the version of genes they carry for P450 enzymes. According to Green, “adverse drug-drug interactions are a well-known problem…. Now that we can see those state changes on a molecular level, a deeper investigation is possible.”

The wide variation in enzymatic reactions, says Green, causes very real consequences. People with two copies of variant alleles are poor metabolizers, people with two copies of the standard genetic variety are normal metabolizers, whereas people with one of each are “reduced” metabolizers. (People who inherit multiple copies of the alleles become “ultrarapid” metabolizers.)

 “With a drug such as caffeine, for example, one population of people might be fast metabolizers, while another might metabolize the drug more slowly,” Green said. "Because the risk of caffeine-induced heart attack may be higher in slow metabolizers, the ability to actually take a snapshot of the phase changes of the P450 enzymes could help us to understand better how certain chemicals can affect people in vastly different ways."

There are dozens of specific cases like the caffeine example. Moreover, the genetic situation is complicated by other factors.  Writing in American Family Physician, Tom Lynch and Amy Price explain that cytochrome P450 enzymes “can be inhibited or induced by drugs, resulting in clinically significant drug-drug interactions that can cause unanticipated adverse reactions or therapeutic failures. Interactions with warfarin, antidepressants, antiepileptic drugs, and statins often involve the cytochrome P450 enzymes.” Testing for these interactions is expensive, and “it has not been determined if routine use of these tests will improve outcomes.”

Not a pretty picture. And just to further complicate matters, some drugs can induce or inhibit CYP450 enzymes differentially, depending upon the dosage. “For instance,” write Lynch and Price, “sertraline (Zoloft) is considered a mild inhibitor of CYP2D6 at a dose of 50 mg, but if the dose is increased to 200 mg, it becomes a potent inhibitor. Inhibitory effects usually occur immediately.” Also, drugs can be metabolized by, and at the same time serve to inhibit, the enzyme in question, as in the case of erythromycin.

So it is buyer beware, and listen to your body’s feedback when embarking on a course of new drugs. Recommended dosages are just that: recommendations. If you feel that the drug in question is doing too much or too little, ask your prescribing doctor about drug-drug interactions and about fast and slow drug metabolizers. Of course, they should be telling YOU about that, but.

Some known enzymatic drug interactions to bear in mind:

Drugs that potentially inhibit P450 enzymes—Tagamet, Cipro, Luvox, Prozac, Flagyl, Benadryl, Paxil, Lamisil, and grapefruit juice.

Drugs that potentially increase the activity of P450 enzymes—Tegretol, phenobarbital, tobacco, Dilantin, rifampin, St. John’s wort.

------

Adverse drug-drug interactions involving P450 enzymes:

Amiodarone (Cordarone) combined with Warfarin (Coumadin): possible bleeding due to increased warfarin activity.

Tegretol, phenobarbital, and Dilantin combined with contraceptives containing ethinyl estradiol: possible unplanned pregnancies due to reduced contraceptive activity.

Clarithromycin, erythromycin, and telithromycin combined with Zocor: possible muscle disorders due to increased Zocor levels.

Prozac combined with Risperidone (Risperdal): increased risk of adverse effects from the antipsychotic drug risperidone.

Grapefruit juice combined with Buspirone (Buspar): Dizziness and other effects of “serotonin syndrome” due to increased buspirone activity.


Rittle, J., & Green, M. (2010). Cytochrome P450 Compound I: Capture, Characterization, and C-H Bond Activation Kinetics Science, 330 (6006), 933-937 DOI: 10.1126/science.1193478

Graphics Credit: http://elcamino.dnadirect.com/

The Day After

How’s that no-smoking pledge going?

This post is not meant for most of you. Those of you who never smoked, or smoked and quit successfully—move along, maybe check out my earlier posts about smoking this month.

But for those of you who have decided to take the 35th annual Great American Smokeout seriously—for those of you who decided today, or yesterday, or recently, to quit smoking—I have a few remarks, if you have a moment. I’m fairly trustworthy on this subject. I’m a science writer, I follow the field of addiction science, and I smoked a pack of Camel filters a day for about 25 years. In addition, I quit smoking using the most recently available smoking cessation aids—nicotine patches and anti-craving medication, in this case Zyban, a.k.a. Wellbutrin.

I had decided, after the usual smoker’s run of unsuccessful independent quitting attempts, that the only real hope I had for success was to throw myself into the hands of my primary care physician. Happily, Dr. Joe is a young example of the last of the breed, a lingering remnant of a tribe that used to be known as family doctors. When I told Dr. Joe of my plans to quit smoking, he was overjoyed. Too overjoyed, it seemed to me. As it turned out, there were grounds for my suspicion. Dr. Joe had recently returned from a smoking cessation seminar at the Mayo Clinic in Rochester, Minnesota, with a grab bag of refinements and alternative approaches for setting up a no-smoking regimen. Furthermore, he made it clear that, if necessary—if I forced him to it through relentless noncompliance—he was fully prepared to order regular blood workups to detect and quantify my nicotine levels.

Of course, I instantly regretted setting a foot into this ring, but once Dr. Joe started flinging prescriptions for patches and pills my way, I realized I was in it up to my wallet (Insurance companies weren’t paying for nicotine cessation products, ever, at that time).

Most smokers know the current drill. A few weeks with nicotine patches or gum or nasal spray, combined with a short course of Zyban or Chantix to further reduce cravings, and then you are expected to fly out of the nest and spread the good news.  Most smokers know that even this controversial armamentarium is not going to completely spare them from a rare and special kind of suffering: addictive craving for nicotine.  It’s a mean, rough ride, as everyone knows.

But if you take a few of the major potholes out of the road, smooth over the really big bumps just a little, fill in the low spots a bit as well, you have a fighting chance—especially if you have tried and failed before (almost nobody pulls it off on the first attempt).

Here are the key features of the program, as my doctor worked it up for me:

--Stronger patches. Mayo Clinic and other institutions had made an important discovery, my doctor said. People weren’t wearing strong enough patches. There was a system of matching up patch strength to amount and duration of smoking, and then a step-down procedure, to less and less powerful patches, and it was all listed on the packages, but because of great nervousness over medical complications by a very few individuals who overdid the patch and then chain-smoked on top of that, the result was that the patches as marketed weren’t strong enough, many doctors felt. The advice was to start strong, with the strongest patch available (and perhaps there was even a patient or two who doubled up, ahem). 

--Longer patches. Start strong—and go long. The whole nicotine replacement plan is supposed to last a month or two. Phooey, said Dr. Joe. No telling in advance how long the process will take. There is no set timetable. How long would I be wearing patches and tapering the dose? As long as it took, Dr. Joe inferred, for me not to need them anymore. He seemed prepared to keep me on patches the rest of my life, if it kept me from picking up a cigarette. In the end, when I took off my final, tiny patch, I had been using them for a little less than six months. The recommended five-star treatment plan in the literature and on the packages calls for only 10 weeks, tops.

--Pharmaceuticals. It is admittedly hard to separate out placebo effects from drug effects, in the case of something as elusive as cigarette urges. But I do believe that Zyban took the edge off the worst of my cigarette cravings. It did not eliminate them, anymore than the patches eliminated them. But the medication effectively dissipated the grip of that moment of panic, when you have risen from your chair and set about finding your coat and car keys for a run to the gas station to buy a pack of cigarettes. Or at least that’s the way it felt to me.

--Exercise. Trite? You bet, and you can be sure that I winced and offered a tired smile when I heard my doctor bore in on the subject. Since I knew him to be a crazed bicyclist, I was prepared to disregard most of what he had to say. But his insistence sent me back to the research literature on exercise and its effect on dopamine, serotonin, acetylcholine, and endorphin levels. So I took him up on that firm suggestion as well, and found that, at the least, it helped with a period of rocky sleep in the beginning.

--Diet. No huge changes, just watching the sweets in an effort to avoid surging blood sugar levels. Fruit helps, since constipation is a common side effect of nicotine cessation—just the opposite of how it works with heroin. I continued to drink coffee, but for a while it didn’t taste as good.

--Relaxation. Quitting smoking makes you tense. You think I’m being funny? Quitting smoking makes you tense all over, mentally and physically. During the first few days you’ll notice that your body is clenched, held rigidly. Your posture is likely to be anything but relaxed; your physical movements can be jerky and awkward. A few minutes a day spent sitting with eyes closed, in a relaxed upright posture, thinking of nothing or concentrating on your breathing or meditating either formally or casually, can bring partial relief from all that tension. And on some days, that can be crucial.

--Determination. Unfortunately, it wasn’t until everyone around me—my wife, children, parents, close friends, work associates—had all, I sensed, basically given up on me, silently condemning me to the category of Lifetime Smoker, that I finally managed to make a successful run at a major life problem. There are better ways to work up your determination. Find and employ them.

With time, an involved partner, nicotine replacement, and the right medication, the deal can be done. There has never been a better time in history to be a smoker who has decided to quit.

Graphics Credit: http://adoholik.com/

New Warning Labels for U.S. Cigarettes; Big Tobacco on the Rampage

Philip Morris Intl. sues Uruguay and Brazil.

Lots of developments on the nicotine front these days. On opposite ends of the news spectrum, so to speak, the Food and Drug Administration (FDA) announced plans to slap new and much more graphic warning stickers on cigarette packs--while elsewhere in the world, the world’s major tobacco companies got busy fighting tougher regulations on cigarette marketing. Meanwhile, the state of California has set limits on the marketing of e-cigarettes, disallowing companies from promoting the nicotine inhalers as “smoking-cessation devices.”

So let’s get busy. In the first significant change for cigarette advertising in 25 years, the FDA, freed by Congress last year to regulate tobacco products, will select nine new designs from among 36 contenders for new, far more graphic warning labels on cigarette packages. The new warning labels will begin appearing in about a year. To view the contenders, go to www.fda.gov/cigarettewarnings.

But will new, grisly images of dying smokers and rotted lungs really make a difference to the roughly one-quarter of adult Americans who still smoke?  “I am pleasantly shocked that [they are] doing this,” Stanton A. Glantz, a tobacco researcher at UC San Francisco, told the Los Angeles Times.  “There is no question but that strong graphic warning labels work,” he said. “Right now we have the weakest warning labels in the world. Now we will be right up there tied for the strongest.”

No so fast, counters John F.  Banzhaf, the executive director of Action on Smoking and Health and a George Washington University law professor. In the same L.A. Times article, Banzhaf said he was “quite disappointed,” stating that the agency “has done nothing more than exactly what Congress told them to do, and not one iota more.” So far, the FDA has banned advertising in magazines for young people, nixed the marketing ploy of handing out free samples on the street, and forbidden tobacco companies from marketing cigarettes by using the words “light” or “low-tar.”

Perhaps a more important result of Congressional approval of FDA oversight is that Medicare has now changed its rules to include smoking cessation products for covered beneficiaries. Previously, only people dying of lung disease were approved for smoking cessation products—a bit late in the disease cycle to do anybody much good.

According to a variety of estimates from government and research agencies, as many as half a million Americans die prematurely from smoking-related diseases. The Department of Health and Human Services has lately been stymied by a smoking rate of about 20%, basically unchanged since 2004. In 1965, about 42% of Americans smoked. The Department of Health and Human Services (HHS) has a stated goal of bringing smoking levels down to 12% by 2020.

That will not be an easy target to hit. And neither Congress nor the FDA nor HHS can count on anything amounting to cooperation from the cigarette giants. The New York Times, in an article by Duff Wilson, notes that worldwide cigarette sales rose 2% last year, as cigarette companies increasingly shift their marketing efforts toward a hunt for new customers in developing countries.  The aggressive nature of the worldwide cigarette marketing push was underscored this year when Philip Morris International sued the governments of Uruguay and Brazil, claiming that those countries had enacted tobacco regulations that were excessive and a threat to the company’s trademark and property rights.

Dr. Douglas Bettcher of the World Health Organization’s Tobacco Free Initiative accused the company of “using litigation to threaten low- and middle-income countries.” Philip Morris subsidiaries are also filing suits in Ireland and Norway over display advertising prohibitions. (Philip Morris USA, a separate division, is not involved in these lawsuits, and did not join with R.J. Reynolds and other tobacco companies in filing suit against the FDA last year.)

In the New York Times article, Wilson writes:

Companies like Philip Morris International and British American Tobacco are contesting limits on ads in Britain, bigger health warnings in South America and higher cigarette taxes in the Philippines and Mexico. They are also spending billions on lobbying and marketing campaigns in Africa and Asia, and in one case provided undisclosed financing for TV commercials in Australia.

As tobacco expert Dr. Cynthia Pomerleau points out on her blog, low smoking rates among women in the developing world make them a particularly tempting marketing target for the tobacco industry. Pomerleau, research professor emerita in the University of Michigan’s Department of Psychiatry, also reminds us that “the real goal here is not to remove health warnings altogether—health warnings have actually worked well for them by legitimizing the claim that if people choose to smoke, it’s not their fault—just to prevent them from dominating the package and actually becoming salient.”

It is important for the industry, says Pomerleau, to publicize “effects that can be achieved or problems that can be addressed by smoking.” In this respect, Pomerleau is concerned about the likelihood that the tobacco industry will seize upon the relationship between smoking and thinness as the wedge for sales campaigns aimed at women. “If it worked in the U.S., why not in Africa or Asia or South America?”

And finally, under a consent judgment worked out with California state Attorney General Jerry Brown, the Florida-based Smoking Everywhere company, a distributor of electronic cigarettes, has agreed not to target minors in its advertising, or to make claims that its products are safe alternatives to tobacco. The move comes shortly after the FDA announced plans to regulated battery-powered e-cigarettes as new drug delivery devices. Smoking Everywhere distributes e-cigarettes manufactured in China. The consent judgment also bars the company from selling its products in vending machines, and requires the products to contain warning labels about the dangers of nicotine.

And don’t forget: Thursday, November 18 marks the 35th annual Great American Smokeout.

More Vanishing Cigarettes

Churchill, Bette Davis, Don Draper, and Pecos Bill.

In my last post, I highlighted some examples of attacks on cultural history represented by cigarette censorship, to wit: a cigarette taken out of the hand of Paul McCartney, and out of the mouths of Jackson Pollock and Burt Reynolds.

But that is only the tip of the iceberg for cigarette revisionism. Other examples:

--Jean-Paul Sartre. A legendary smoking icon, Sartre was no doubt rolling in his grave over the decision by the Bibliotheque Nationale of France to airbrush away his ever-present cigarette in an exhibition poster marking the 100th anniversary of his birth.

--Winston Churchill. Perhaps the most famous cigar smoker in history, the British Prime Minister suffered the indignity of having his cigar air-brushed out of the famous 1948 photograph of him making the “V” sign for victory. As you can see in the photograph above, that moment in history is no longer with us. Instead, Churchill looks like he is beginning to develop lip cancer.

--Tom and Jerry, Fred Flintstone, and Pecos Bill. Famous cartoon characters who occasionally, for purposes of satire or humor, were seen smoking cigarettes, and whose famous smoking scenes have been edited out by nervous broadcasters over the years. 

--Bette Davis. Another iconic cigarette smoker, she also ran afoul of the U.S. Postal Office (see Jackson Pollock in the post below). When the Post Office offered its Bette Davis stamp in 2008, it was inspired by a still photo from the film "All About Eve." As film critic Roger Ebert wrote at the time: “Where's her cigarette? Yes reader, the cigarette in the original photo has been eliminated. We are all familiar, I am sure, with the countless children and teenagers who have been lured into the clutches of tobacco by stamp collecting, which seems so innocent, yet can have such tragic outcomes.”

--And finally, there is the contemporary case of Don Draper of TV’s “Mad Men,” the only current television show truly obsessed with the cultural significance of smoking.  Indeed, the series opened its first season with a show called “Smoke Gets in Your Eyes,” in which advertising execs devised a pitch for Lucky Strikes. And the arresting title sequence that opens every show ends with a memorable black and white graphic of Don Draper seen from behind, seated on a couch, a cigarette held firmly in hand. “Bizarrely,” write Chris Harrald and Fletcher Watkins in The Cigarette Book: The History and Culture of Smoking, “this pleasure was denied to the man in the Mad Men promotional video for Season 1, when shown on Apple’s iTunes. The original image of a man seen from behind lounging in silhouette, right hand outstretched with a cigarette in it, has had the cigarette digitally removed.” (It has since been restored).

Photo Credit: CORBIS/Stephanie Schaerer

When Presidents Smoke

And a word about famous cigarettes that vanish.

I gave Obama a pretty hard time during the campaign and the first half of his presidency, for sneaking off to furtively field-strip the odd Marlboro. So it seems only fair to take a moment and point out the illustrious forefathers that have paved the way for today’s presidential indiscretions.

The source here is an illustrative and very funny book of cigarette history called, straightforwardly enough, “The Cigarette Book: The History and Culture of Smoking,” by Chris Harrald and Fletcher Watkins.

In the preface, the authors write: “One day the last cigarette on earth will be smoked. One final puff will be sent heaven-bound, leaving a lingering, evanescent smoke-ring…. The ubiquity of the cigarette is astounding. But soon it will be no more.”

A few factoids about U.S. Presidents and smoking:

-- John Quincy Adams. Pipe. A prodigy, he took up smoking at the age of eight.

-- Zachary Taylor. Chewing tobacco. Claimed he could hit White House spittoons from a distance of 12 feet.

-- Rutherford B. Hayes. First killjoy to ban smoking in the White House.

-- William McKinley. “Frantic cigar smoker.” Was known to break open cigars and chew the tobacco.

-- Calvin Coolidge. 12-inch cigars. Mrs. Coolidge, with her secret cigarette habit, may have been the first smoking First Lady.

--Herbert Hoover. “Chain-smoker.”

-- Franklin D. Roosevelt. “Paraplegic chain-smoker.”

-- Harry Truman. Banned smoking at official White House events.

-- Dwight D. Eisenhower. Rolled his own. Quit before the inauguration.

-- John F. Kennedy. “Cuban cigars.” Bought 1,200 of them the day before signing the Cuban embargo. Jackie was, it is said, good for up to three packs of Salems a day.

-- Lyndon B. Johnson. Ferocious cigarette smoker. A habit of 60 smokes a day is assumed to have caused the first of three heart attacks.

-- Gerald Ford. “Pipe. Eight bowls a day.”

-- Ronald Reagan. Did not smoke as president, but will be forever remembered for shilling Chesterfields in the 1940s: “My cigarette is the mild cigarette… that’s why Chesterfield is my favorite.”

In most of these presidential cases, the smokers in question were less than fully candid with the general public about their habits. But even more interesting, and rather chilling, are examples of revisionist censorship—making famous cigarettes in famous photographs mysteriously disappear, for the sake of cultural correctness.

The authors of “The Cigarette Book” start out with a swift punch to the midsection: “A recent poster featuring the famous album cover of Abbey Road (1969) removes the cigarette from Paul McCartney’s hand” (Italics mine, to reify the significance of the offense).

And readers of a certain age will recall (or recall hearing of) (or deny knowing anything about) a nude Burt Reynolds as a Playgirl magazine centerfold in 1972, with a cigarette dangling suggestively from his mouth. But when the image was reissued 35 years later, as part of an HD TV ad campaign, the cigarette, the authors tell us, “had been Photoshopped out of existence. Now it would probably be more acceptable to see his genitals than to see him smoking.” (Then again, maybe not.)

And in 1999, the U.S. Postal Service issued a Jackson Pollock stamp, using an iconic photograph from Life Magazine, showing the artist with a cigarette between his lips. “The Postal Service used the photo, but digitally removed the cigarette.” And perhaps added a little collagen to the lips, as well?

Finally, there is the case of chain-smoker Joseph Stalin, and the insane anti-smoker Adolf Hitler. Hitler had a cigarette removed from a famous photo of Stalin circulated at the time of the non-aggression pact. “Hitler felt it was bad for Germans to see such a ‘statesman’ (Hitler’s term) with a cigarette between his fingers.”

Photo credit: LBJ Library

Meet Sara Bellum

It’s National Drug Facts Week.

Let’s face it: Most groups, movements, associations, programs, textbooks, and videos that attempt to instill an anti-drug message in our nation’s youth are lame beyond belief. From “Reefer Madness” to “This is Your Brain on Drugs,” adults have managed to inculcate one overriding message in the nation’s young people: When it comes to drugs and alcohol, you can’t count on older people to tell you the truth.

So, in honor of National Drug Facts Week, it is with pleasure that I point to the Sara Bellum Blog, maintained by the National Institute on Drug Abuse (NIDA) and dedicated to the notion that tweens and teens might be as interested in straightforward drug facts as anybody else. Here is what the blog has to say about itself:

The Sara Bellum Blog is written by a team of NIDA scientists, science writers, and public health analysts of all ages. We connect you with the latest scientific research and news, so you can use that info to make healthy, smart decisions.

Sometimes it can be hard to know where to go for the truth about drugs. Here at NIDA, we learn from science—not from rumors or gossip. We have thousands of researchers around the world who study drug addiction and come up with ways to help people recover and live healthy lives. Every day, scientists and physicians discover more about how drugs affect your brain and body.

You owe it to yourself to ask the right questions, look for the facts, and think hard about what you find out and what it means for you. We’re here to help you do that.

The year-old blog has been recognized as one of the top government blogs, and is targeted primarily at 12 to 17 year-olds. There is an “Ask Dr. NIDA” feature, and a National Drug I.Q. Challenge, which you can take here.

I scored 18 out of 20. But I nailed the bonus round, 5 for 5.

Articles at the site include:

· How Does Cocaine Work? It's Partly In Your Genes

· NIDA News: NIDA's Chat Day, More Questions on Marijuana

· Real Teens Ask: Do Many Kids in High School Do Drugs?

· Real Teens Ask: Can inhaling Sharpie markers make you high?

· Binge Drinking Matters--To Your Brain

· NIDA News: Back to the Future?

· Meth Mouth and Crank Bugs: Meth-a-morphosis

· Real Life: Eminem and Elton John

· NIDA News: Who Gets Fooled by Flavors?

In addition, here are some comments made by the blog's editor, Jennifer Elcano, and posted at Sara Bellum:

We thought it would be a good strategy for conveying drug abuse facts and prevention messages to teens, because we could tweak a blog format to offer brief and regularly updated content and keep it current and interesting. And a lot of our other publications geared to teens were longer or in book or brochure format. The blog allowed us a way to post short and topical items of interest to teens and also to elicit their instant feedback on what they were reading about, what we were offering them, so we could continue to adjust it as time went on since it was such a new thing.

Sara Bellum has a long history at NIDA and has appeared in a lot of our print publications in prior years. If you Google her, you can see some of our past publications where she appears as a fictional NIDA adventurer, scientist, and explorer with a big looking glass. She would be investigating the science behind drugs and their effects on the brain and the body. So what we did with the blog is basically update this character to be more of a “chic geek” type.”

I am really proud of the fact that we took a risk as a federal government agency in allowing a blog where moderated comments were permitted. We have fairly liberal guidelines, so we will only not post comments if they contain profanity, denigrate people or groups of people, or contain spam or link to outside websites. They are very basic rules mainly to protect the site’s integrity and the commenters themselves, who sometimes disclose identifying information that should stay private. I am glad we have been able to do this in a climate that tends to be averse to taking these kinds of risks.

Photo Credit: http://teens.drugabuse.gov

Mephedrone, the New Drug in Town

Bull market for quasi-legal designer highs.

Most people in the United States have never heard of it. Very few have ever tried it. But if Europe is any kind of leading indicator for synthetic drugs (and it is), then America will shortly have a chance to get acquainted with mephedrone, a.k.a. Drone, MCAT, 4-methylmethcathinone (4-MMC), and Meow Meow--the latter nickname presumably in honor of its membership in the cathinone family, making it chemically similar in some ways to amphetamine and ephedrine. But its users often refer to effects more commonly associated with Ecstasy (MDMA), both the good (euphoria, empathy, talkativeness) and the bad (blood pressure spikes, delusions, drastic changes in body temperature).

Some of the best stateside coverage has come from the anonymous NIH researcher who blogs on science topics as DrugMonkey. The whole business of what mephedrone does is complicated, he writes. The cathinone structure is “very similar to amphetamine and supports parallel modifications,” but there is clearly an “MDMA-like component to this mephedrone stuff.” (See additional DrugMonkey coverage here  and here.)

Until earlier this year, mephedrone was in that weird state of limbo LSD found itself occupying in the mid-1960s: legal, but not for long. States are attempting to sweep synthetic drugs of abuse like Spice and other cannabinioid derivatives into a proscribed package that includes mephedrone.  Federal authorities are able to prosecute under The Analogue Drug Act of 1986, which was designed to combat this dilemma in the United States by outlawing drugs “substantially similar” to any drug that is already illegal. However, “chemical experts disagree on whether a chemical is 'substantially similar' in structure to another chemical—so much so that Federal Analogue Act litigation often degenerates into a 'battle of experts,' which is founded more on opinion than on actual scientific evidence,” writes Gregory Kau in an article for the University of Pennsylvania Law Review.

It is clear by now that this cat-and-mouse game is rigged in favor of the designers and suppliers of new drugs under the sun. Exploiting the gray zone of quasi-legality is extremely profitable. One outlaw chemist told Jeanne Whalen of the Wall Street Journal that by the time law enforcement closes in, “we are going to bring out something else.” At which point, prosecutorial mechanisms put in place for mephedrone must be laboriously recreated for the new drug.

This drug entrepreneur, and others like him, makes extensive use of the Internet, especially in Europe, since mephedrone is not universally banned. To keep the business technically legal, sellers label mephedrone “not for human consumption” and market it as anything from plant food to bath salts.  Sometimes they draw unwanted attention to themselves through the purchase of lab equipment, like the rotary evaporator pictured above. 

Mephedrone has lately been covered relentlessly by the British press, after the deaths of three young people in the U.K. and Sweden were attributed to mephedrone. Part of the difficulty in assessing the danger and addictiveness, if any, of these newer substances is that most of them have not been subjected to controlled clinical testing on humans. (One hardy purveyor of mephedrone snorted half a gram of the drug on a Belgian news program to demonstrate his side of the argument.)

Media hysteria in the U.K. led to reports of dozens of deaths due to mephedrone, none of which have thus far proven to be indisputably the result of ingesting mephedrone. As British politicians rushed to enact a ban, Danny Kushlick of the drug charity Transform told the U.K. Guardian in April: “The misreporting of mephedrone deaths is a crass example of the potentially lethal alliance between press and politicians that by default ends in a ban that often creates far greater harms than those caused by use.”  In July, BBC News reported that the mephedrone crackdown was “floundering”, even though the ban had been widened to included a near-beer version of mephedrone called Naphyrone (sold as NRG1). But a spokesperson for Lifeline, another British drug charity, argued that “you can’t just ban your way out of a problem because it could result in far more dangerous chemicals coming onto the market.” According to the European Monitoring Centre for Drugs and Drug Addiction, which operates the EU early-warning system on new drugs in cooperation with Europol,  “24 new psychoactive substances were officially notified for the first time to the two agencies in 2009.”

The National Drug Intelligence Center at the U.S. Department of Justice reported that early in the year, “several individuals in the Bismarck [North Dakota] area ingested or injected illicit products containing mephedrone and required hospitalization. In addition, the Oregon State Police Forensic Laboratory (Bend, Oregon) received two submission of white power that users referred to as ‘sunshine.’ Both submissions tested as mephedrone.”

And now comes a report from North Carolina of two fatalities allegedly linked to the use of mephedrone, as reported by David Kroll at Terra Sigillata.

Narcotics officials and toxicologists say that the raw materials for many of the new drugs appear to be manufactured in China and trans-shipped to other countries in Southeast Asia and the Middle East. DrugMonkey also notes that it will be interesting to see “if actions such as Cambodia, Vietnam, and Thailand finally getting serious about controlling the production of the safrole oil used as a precursor in MDMA manufacture is having a lasting effect on world markets.”

Photo Credit: http://www.ipfw.edu/