Summer House

Times Union — Tatum O’Neal, the Oscar-winning actress, took a plea deal last week stemming from her June 1 arrest while supposedly trying to score some crack cocaine on the Lower East Side of Manhattan. She was initially charged with possession of a controlled substance and faced a year in prison if convicted. The court allowed her to plead out to a disorderly conduct charge and ordered her to attend two half-day drug treatment sessions. If she follows the court’s orders, the cocaine possession charges will be dismissed.

O’Neal has been open about her history of heroin addiction as outlined in her memoir, "A Paper Life." When she was arrested by undercover officers, they searched her and found two bags of cocaine along with an unused crack pipe. She had initially told police she was doing research for an acting role. Then she changed her story and told them that the death of her 16-year-old dog nearly triggered her into relapse.

Some say O’Neal was treated with a slap on the wrist. Others say she did not deserve to do any jail time because of her addiction. This raises a critical question that we as a society need to address. Should we treat drug addiction as a criminal matter, or as a medical problem?

For most people, treatment is a much more effective approach than imprisonment for successfully breaking their addictions, yet our prisons are full of individuals whose only crime is their drug addiction.

According to Justice Department statistics, the United States has more prisoners than any country in the world, 2.5 million and rising. In 2006, the Justice Department recorded the largest increase since 2000 in the number of people in prisons and jails. Criminal justice experts attribute the exploding prison population to harsh sentencing laws and record numbers of drug law violators entering the system, many of whom have substance abuse problems.

Nonviolent drug offenders like Tatum O’Neal should be given an opportunity to receive treatment, not jail time, for their drug use. This would be a more effective (not to mention much more affordable) solution for both the individual and the community. Prosecutors in many states, most notably New York, have leeway to recommend a defendant to treatment instead of incarceration. More than likely, however, they will not do it. This is because it would not be considered a victory for them. The system does not reward prosecutors for doing the compassionate thing.

O’Neal can be an example for millions of young people. One can only hope that her experiences with addiction and the realities of the drug war will encourage her to join the movement to reform U.S. drug policy. If she decides to take up the cause of treatment, she could help change laws across the country. After all, if treatment instead of jail is good enough for her as she struggles with her addiction, surely it is good enough for the thousands of others just like her who struggle with their own substance abuse problems.

Like depression, addiction affects tens of millions of Americans. How best to treat it is a serious a question we need to explore. Rich or poor, young or old, addiction has no boundaries. But the drug war does. Our long war on drugs has stifled the open debate society should be having about the nature of addiction and how best to deal with it. It is time to treat addiction for what it is — a medical problem, not a criminal one.

Fox News — The U.S. leads the world in marijuana and cocaine experimentation, as well as in lifetime tobacco use, according to a survey released this week by the World Health Organization.

For the survey, which was partially funded by a division of the U.S. National Institutes of Health, researchers at the University of New South Wales in Sydney, Australia looked at drug, alcohol and tobacco use in 17 countries throughout North and South America, Europe, Asia, the Middle East, Africa and Oceania. More than 54,000 people participated in the survey.

"The United States, which has been driving much of the world’s drug research and drug policy agenda, stands out with higher levels of use of alcohol, cocaine, and cannabis, despite punitive illegal drug policies, as well as (in many U.S. states), a higher minimum legal alcohol drinking age than many comparable developed countries," the authors wrote in the study, which was published in the July 1 issue of the journal PLoS Medicine.

"The Netherlands, with a less criminally punitive approach to cannabis use than the U.S., has experienced lower levels of use, particularly among younger adults," they added.

The U.S. had the highest percentage of respondents admitting to lifetime tobacco use at 74 percent, followed by Lebanon at 67 percent, and Mexico and the Ukraine at 60 percent, according to the study.

The lowest percentages of lifetime tobacco use were found in the African countries of South Africa with 32 percent and Nigeria with 17 percent.

More U.S. respondents said they used marijuana at 42.4 percent, followed by New Zealand at 41.9 percent. Lifetime marijuana use was virtually non-existent in Asian countries, however.

Sixteen percent of U.S. survey participants said they used cocaine at least once, followed by Colombia, Mexico, Spain and New Zealand where between 4 and 4.3 percent of respondents admitted to use.

The only area where U.S. respondents trailed was in alcohol use. Almost 92 percent of U.S. respondents said they used alcohol, compared to 97 percent of Ukrainians and 95.3 percent of Germans. Just 40 percent of South African respondents used alcohol.

NEW YORK (Reuters Health) - Infants born to women with substance abuse problems will fare better if their mothers undergo treatment for these problems early in pregnancy, according to the largest study to date to investigate this issue.

In fact, they did just as well as babies born to mothers who didn’t have issues with drug or alcohol use on nearly all of the measures the researchers looked at, Dr. Nancy C. Goler of The Permanente Medical Group in Vallejo, California, and her colleagues found.

"It is time for our nation to look at the issue of substance abuse in pregnancy with a non-judgmental, coordinated, effective intervention that all pregnant women can easily access," they write in the Journal of Perinatology. Such treatment should become the "national standard," Goler and her team urge.

Kaiser Permanente Northern California (KPNC) screens pregnant members for substance abuse with questionnaires and urine tests and offers "state of the art" treatment through its Early Start program, the researchers explain in their report. Women identified as having problems receive care from a specialist in both prenatal care and substance abuse treatment who is based at her local Woman’s Health Clinic.

To evaluate the program’s effectiveness, the researchers looked at outcomes for 49,985 women who underwent screening at KPNC clinics from January 1, 1999 to June 1, 2003. They compared four groups: the 46,553 women who screened negative for substance abuse problems (control group); 2,073 who screened positive and underwent treatment; 1,203 with substance abuse problems who were assessed as part of the Early Start program but weren’t treated; and 156 who tested positive for substance abuse but weren’t assessed or treated.

Most women in each of the four groups received the same amount of prenatal care, but the control and treatment groups were more likely to begin prenatal care before 13 weeks of pregnancy than women in the other two groups.

The rates of 8 of the 10 maternal or fetal complications the researchers evaluated were similar for the control group and the group of women who received treatment. However, infants born to treated women were slightly more likely to be low birth weight or to require admission to the newborn intensive care unit.

Infants born to women treated for substance abuse were less likely to require assistance in breathing shortly after birth than babies born to women with substance abuse issues who weren’t assessed or treated, Goler and her colleagues found. And fewer of these infants were preterm or low birth weight.

Rates of these and other complications for babies born to mothers who were assessed but not treated for substance abuse were generally between those of the treated women and those who weren’t assessed or treated.

Substance-abusing women who weren’t assessed or treated were significantly more likely than any other women in the study to develop a serious pregnancy complication called placental abruption. Their risk was nearly seven times as great as that for women in the control group. The fetuses of these women also were 16 times more likely to die in utero compared to the control group, while rates of fetal death for women who were assessed or assessed and treated weren’t significantly different from the control group.

Before KPNC initiated its Early Start program, Goler and her team point out, women diagnosed with substance abuse issues were referred to outside treatment programs, but typically didn’t show up for these appointments.

The Early Start model of care "affords women easy access to the program by removing both the physical and emotional barriers that can be overwhelming in pregnancy," the researchers conclude.

New York Times - According to the White House, this country is scoring big wins in the war on drugs, especially against the cocaine cartels. Officials celebrate that cocaine seizures are up — leading to higher prices on American streets. Cocaine use by teenagers is down, and, officials say, workplace tests suggest adult use is falling.

John Walters, the White House drug czar, declared earlier this year that “courageous and effective” counternarcotics efforts in Colombia and Mexico “are disrupting the production and flow of cocaine.”

This enthusiasm rests on a very selective reading of the data. Another look suggests that despite the billions of dollars the United States has spent battling the cartels, it has hardly made a dent in the cocaine trade.

While seizures are up, so are shipments. According to United States government figures, 1,421 metric tons of cocaine were shipped through Latin America to the United States and Europe last year — 39 percent more than in 2006. And despite massive efforts at eradication, the United Nations estimates that the area devoted to growing coca leaf in the Andes expanded 16 percent last year. The administration disputes that number.

The drug cartels are not running for cover.

Mexico and parts of Central America are being swept up in drug-related violence. Latin Americans are becoming heavy consumers of cocaine, and traffickers are opening new routes to Europe through fragile West African countries. Some experts argue that the rising price of cocaine on American streets is mostly the result of a strong euro and fast-growing demand in Europe.

Workplace drug tests notwithstanding, cocaine use in the United States is not falling. About 2.5 percent of Americans used cocaine at least once in 2006, the same percentage as in 2002, according to the Department of Health and Human Services.

While cocaine use has fallen among younger teenagers, 12th graders are using more: 5.2 percent used cocaine last year — up from 4.8 percent in 2001 and 3.1 percent at the low point in 1992, says a Monitoring the Future survey done by the University of Michigan.

All this suggests serious problems with a strategy that focuses overwhelmingly on disrupting the supply of drugs while doing far too little to curb domestic demand.

Washington spent $1.4 billion on drug-related foreign assistance last year — mostly to equip Colombia’s security forces and spray coca crops in the Andes. It spent another $7 billion on drug-related law enforcement and interdiction efforts at home and abroad. It spent less than $5 billion on education, prevention and treatment programs at home to curtail substance abuse.

The counternarcotics effort has produced some successes. Marijuana use in the United States has declined since 2002, the earliest year for which the government has comparable data. Teenage use of other drugs, like methamphetamine, has fallen sharply. With American aid, Colombia’s armed forces have severely weakened the FARC guerrillas, a major player in the drug trade.

The next administration should continue to help Latin American governments take on the traffickers. But it must learn from the current strategy’s shortcomings.

Eradication efforts are most likely to have more success if more money is spent on programs to wean coca growers from the business and improve the lives of their families and communities. Mexico, in particular, is in deep trouble, and the next American president should build on the Bush administration’s plans to provide counternarcotics aid. There needs to be a different mix: less money for equipment for security forces and more for economic development and programs to reform and strengthen Mexico’s judicial system.

Above all, the next administration must put much more effort into curbing demand — spending more on treating drug addicts and less on putting them in jail. Drug courts, which sentence users to treatment, still deal only with a small minority of drug cases and should be vastly expanded. Drug-treatment programs for imprisoned drug abusers, especially juvenile offenders, must also be expanded.

Over all, drug abuse must be seen more as a public health concern and not primarily a law enforcement problem. Until demand is curbed at home, there is no chance of winning the war on drugs.

WASHINGTON (AP) — About 3.1 million people between the ages of 12-25 have used cough and cold medicine to get high, the government reported Wednesday.

 The number of young people who abused over-the-counter cold medicines is comparable to use of LSD and much greater than that for methamphetamine among the age group, according to the federal Substance Abuse and Mental Health Services Administration.

The agency’s 2006 survey on drug abuse and health found that more than 5 percent of teenagers and young adults had misused cough and cold medicines and indicated that these people also had experimented frequently with illicit drugs. Nearly 82 percent also had used marijuana. Slightly less than half also used inhalants or hallucinogens, such as LSD or Ecstasy, the agency said.  The cough suppressant DXM is found in more than 140 cough and cold medications available without a prescription. When taken in large amounts, DXM can cause disorientation, blurred vision, slurred speech and vomiting.

Health Library  -  MayoClinic.com: Robotripping — abusing cough medicine

 
Among all persons aged 12 to 25, the rate of past year misuse among whites was 2.1 percent, which was three times higher than the level for blacks, 0.6 percent, and also significantly higher than the level for Hispanics, 1.4 percent.

"While increasing attention has been paid to the public health risk of prescription drug abuse, we also need to be aware of the growing dangers of misuse of over-the-counter cough and cold medications, especially among young people," said Terry Cline, the agency’s administrator.

Xanax is a Central Nervous System (CNA) depressant known as benzodiazepine, which is commonly prescribed by physicians to treat panic attacks, nervousness, and tension. Xanax, also known as alprazolam, is considered to be a Schedule IV controlled substance under the Controlled Substance Act (CSA). Xanax has been used as a tranquilizer since the 1960s. With strong opposition to the use of benzodiazepines in the 1970s, there was a 25 percent drop in the number of prescriptions written and today, with approximately 3 million Americans (1.6% of the adult population) having used benzodiazepine on a daily basis for at least 12 months, they are the most controversial of all psychotropic medicines.

According to the United States Department of Justice Drug Enforcement Agency (DEA) and under the CSA, all controlled substances are rated on a five-schedule system. Schedule V, the lowest, for the potential for abuse and dependency and I, the highest. Xanax is a Schedule IV. All Schedule IV controlled substances have the following attributes: a low potential for abuse, a currently accepted medical use in treatment in the United States, and if abused, may lead to limited physical dependence or psychological dependence. Other examples of drugs included in schedule IV are Darvon®, Talwin®, Equanil®, Valium®, and Xanax®.

Although there are many benefits to taking Xanax and other Schedule IV drugs, many patients are becoming addicted and therefore require an intervention and drug treatment program to overcome their addictions. The patient’s body can also build up a tolerance to the drug and require larger doses if taken for long periods of time. With these increases in Xanax use come physical and psychological dependencies. Xanax is not drug to quit cold turkey. The Journal of Postgraduate Medicine stated that up to 25 percent of patients who stop taking their medication experienced withdrawal symptoms such as: nausea, vomiting, dizziness, headache, anxiety, irritability, insomnia, chills, lethargy, fatigue, moodiness, crying, dystonia, paresthesia, tremor, vivid dreams, and myalgias.

The National Institute on Drug Abuse found during a two-year treatment outcome study that 15 percent of heroin users also used benzodiazepines daily for more than one year, and 73 percent used benzodiazepines more often than weekly. Studies also indicate that from 5 percent to as many as 90 percent of methadone users are also regular users of benzodiazepines. With this information in mind, the Xanax abuse treatment involves careful monitoring and counseling in an in-patient or outpatient treatment facility. The American Psychiatric Association’s (APA) report on benzodiazepines revealed that 11 to 15 percent of the adult population has taken a benzodiazepine one or more times during the preceding year, but only 1 to 2 percent have taken benzodiazepines daily for 12 months or longer (4). However, in psychiatric treatment settings and in substance-abuse populations, the prevalence of benzodiazepine use, abuse and dependence is substantially higher than that in the general population. Treatment encompasses a patient’s thought process, behavior, and helps them to cope with everyday life. Patients suffering from Xanax addiction should be tapered off gradually. There are basic outpatient plans available for discontinuation of the drug including: gradual discontinuance over a six to 12 week schedule, monitoring and helping the patient to feel in control of their dosage, and supplying a helpline when the patient needs reassurance. Other plans include inpatient treatment centers and 12-step programs such as Narcotics Anonymous, and drug treatment exchanges such as, Clonidine, propranolol, or carbamazepine. Although these substitutes can be dangerous, an inpatient setting where dosages can be physician monitored until the patient can reach a zero dose of the benzodiazepine is recommended.