08/31/14 Doug McVay
Century of Lies
Doug McVay reports: A new drug czar is nominated, research about medical cannabis and opioid overdose, and a discussion with NORML's Paul Armentano.
Doug McVay reports: A new drug czar is nominated, research about medical cannabis and opioid overdose, and a discussion with NORML's Paul Armentano.
Century of Lies August 31, 2014
DEAN BECKER: The failure of Drug War is glaringly obvious to judges, cops, wardens, prosecutors and millions more. Now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century of Lies.
DOUG McVAY: Hello and welcome to Century of Lies. I'm your guest host, Doug McVay, editor of Drug War Facts dot org. Century of Lies is a production of the Drug Truth Network, which comes to you through the Pacifica Foundation Radio Network and is supported by the generosity of the James A. Baker III Institute for Public Policy and of listeners like you.
Find us on the web at drug truth dot net, where you can find past programs and you can subscribe to our podcasts. You can follow me on twitter, where I'm at drug policy facts, and also at doug mcvay. The Drug Truth Network is on Facebook, be sure to give its page a Like, you can find Drug War Facts on Facebook as well, please give it a like and share it with friends.
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Our top story this week: The White House announced on Friday that Michael Botticelli has been nominated to be the next director of the Office of National Drug Control Policy. Botticelli has been the acting drug czar ever since Gil Kerlikowske left the office to take the position of Commissioner of the US Customs and Border Protection Agency.
Botticelli describes himself as an alcoholic in recovery. His professional background is also in substance use treatment. To give a fuller idea about the man and his positions, let's give a listen to some Congressional testimony from earlier this year. This is Botticelli testifying before the Senate International Narcotics Caucus on heroin and opioid use:
MICHAEL BOTTICELLI: Chairman Feinstein, Co-Chairman Grassley, and distinguished members of the Caucus, thank you for this opportunity to address the public health and safety issues surrounding the diversion and abuse of opioid drugs – including prescription painkillers and heroin - in the United States.
I know that given recent media attention to overdose deaths there is a heightened public interest in the threat of opioid drug use. While this might be a new phenomenon for many of our communities some have been dealing with this issue for a very long time and it is a matter of great concern for this administration.
As we discussed, according to the Centers for Disease Control and Prevention drug overdose deaths driven primarily by prescription opioids now surpass homicides and traffic crashes in the number of injury deaths in America.
In 2010 (the latest year in which we have nationwide data) approximately 100 Americans died on average from overdose every single day. Prescription analgesics were involved in almost 17,000 deaths that year and heroin was involved in another 3,000. More recent data proposed by several sources indicated that deaths from heroin continue to increase.
While heroin use remains relatively low in the United States as compared to other drugs there has been a troubling increase in the number of people using heroin in recent years – from 373,000 “past year users” in 2007 to 679,000 in 2012.
It is clear that we can’t arrest our way out of the drug problem. Science has shown us that drug addiction is a disease of the brain, a disease that can be prevented, treated and from which one can recover.
We know that substance use disorders – including those driven by opioids – are a progressive disease. It is important to consider and understand that many people who develop a substance use disorder begin using at a very young age and often start with alcohol and tobacco.
We know that as an individual’s abuse of prescription opioids becomes more frequent or chronic that person is more inclined to purchase these drugs from dealers or obtain prescriptions from multiple doctors rather than simply getting them from friends and family for free without asking.
Left untreated this progression of an opioid use disorder may lead an individual to pursue lower cost and more potent alternatives – particularly heroin. With these circumstances in mind we release the Obama administration’s inaugural National Drug Control Strategy in 2010 in which we set out a wide array of actions to expand public health interventions and criminal justice reforms to reduce drug use and its consequences. That strategy noted opioid overdoses as a growing national crisis and set specific goals for reducing drug use including heroin.
Three years ago the administration released the first comprehensive action plan to combat the prescription drug use epidemic. The Prescription Drug Abuse Prevention Plan strikes a balance between the need to prevent diversion and abuse and the need to ensure legitimate access to prescription pain medication.
The plan expands on the National Drug Control Strategy and brings together a variety of federal, state, local and tribal partners to support improving education for patients and healthcare providers, supporting the expansion of state-based prescription drug monitoring programs, developing more convenient and environmentally responsible disposal methods to remove unused medications from the home, and reducing the prevalence of pill mills and doctor shopping through targeted enforcement efforts. This work has been paralleled by efforts to address heroin trafficking and heroin use.
The administration is also focusing on several key areas to reduce and prevent opioid overdoses including educating the public about overdose risks and interventions; increasing access to naloxone, an emergency opioid overdose reversal medication. Because the police are often the first at the scene of an overdose the administration has strongly encouraged local law enforcement agencies to train and equip their personnel with this life-saving drug. 22 states plus the District of Columbia have implemented a law or developed a pilot program to allow the administration of this medication by a professional or lay person to reverse the effects of an opiate-related overdose.
We are also working with states to promote Good Samaritan laws so that bystanders to an overdose will take appropriate action and help save lives. We are heartened that 17 states plus the District of Columbia have now adopted Good Samaritan laws.
While it is critical for us to save lives we also need a comprehensive response to prevent overdose deaths. A smart public health approach requires us to catch the signs and symptoms of substance use earlier before it develops into a chronic disorder. We are encouraging the use of screening and brief intervention to catch risky substance use before it becomes an addiction.
Since only 11% of those who need substance use disorder treatment in 2010 actually received it the administration has dramatically expanding access to treatment. The Affordable Care Act and parity laws are extending access to and parity for mental health and substance use disorder benefits for an estimated 62 million Americans helping to close the treatment gap and integrate substance use treatment into mainstream health care. This represents the largest expansion of treatment access in a generation and will help guide millions of Americans into successful recovery.
The standard of care for treating substance use disorders driven by heroin or prescription opioids involves the use of medication assisted treatment, an approach to treatment that utilizes behavioral therapy along with FDA-approved medications – either methadone, buprenorphine, and naltrexone. Medication-assisted treatment has already helped thousands of people in long-term recovery. A prime goal of our office is to increase access to medication-assisted treatment within existing treatment programs and integration with primary care.
There are some signs that these national efforts are working. And there are some signs that these national efforts are working. The number of Americans 12 and older initiating the nonmedical use of prescription opioids in the past year has decreased significantly since 2009, from 2.2 million in that year to 1.9 million in 2012. Additionally, according to the latest Monitoring the Future survey, the rate of past year use among high school seniors of OxyContin or Vicodin in 2013 is its lowest since 2002.
Recent studies have shown that the implementation of robust naltrexone distribution programs and the expansion of medication-assisted treatment programs can reduce overdose deaths and also be cost effective. Nonetheless, continuing challenges with prescription opioids and the reemergence of heroin use underscore the need for leadership at all levels of government.
We will, therefore, continue to work with our federal, state, tribal and community partners to continue to reduce and prevent the health and safety consequences of prescription opioids and heroin.
DIANE FEINSTEIN: Thank you. Could you just tell me you said that heroin use has doubled – that’s in the last 5 years?
MICHAEL BOTTICELLI: This is information from the most recent national survey on drug use and health and it looked at people who used heroin in the past year. That went from 373,000 “past year users” in 2007 to 669,000 in 2012.
DIANE FEINSTEIN: So very striking figure.
DOUG McVAY: It's expected that because of his background, Botticelli will be an advocate for treatment.
It was expected that because of Gil Kerlikowske's background as a progressive police chief, we would see less of a law enforcement emphasis because of his understanding of the limitations of a law enforcement-focused strategy. It was expected that Barry McCaffrey would bring in less of a law enforcement emphasis because as a retired military officer, McCaffrey would understand the limitations of a drug war-oriented strategy. It was hoped that Bill Bennett, as a former education secretary and head of the national endowment for the arts, would put more emphasis on prevention and education. All of those hopes were of course dashed like the pipe dreams they were after reality reared its ugly head.
In the words of the musician, songwriter and poet Pete Townsend:
“I'll tip my hat to the new constitution Take a bow for the new revolution Smile and grin at the change all around me Pick up my guitar and play Just like yesterday And I'll get on my knees and pray We don't get fooled again.”
Welcome to the job, Mr. Botticelli.
Sunday, August 31 is International Overdose Awareness Day. Harm reduction supporters and drug policy reform advocates around the world will be taking the opportunity to spread the word about naloxone and about other harm reduction approaches which can minimize the risk of a drug overdose.
That leads us to this next story:
An article recently published in a journal from the American Medical Association, JAMA Internal Medicine, reports that state medical cannabis laws may be having a positive impact on opioid overdose deaths. The article is titled "Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010 ." The researchers found, "States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time:"
They concluded, "Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates. Further investigation is required to determine how medical cannabis laws may interact with policies aimed at preventing opioid analgesic overdose. "
Now, it's important to approach these results with caution. These data show a correlation yet they don't prove causation. That is, we don't know for sure that access to legal medical cannabis has actually caused the lower mortality rates, that's why more research is needed, there could be other confounding factors. On the other hand, previously published surveys of medical cannabis patients show that many report having reduced their use of prescription medications as a result of medical cannabis use, so perhaps we will find proof of causation. I can think of three ways in which medical cannabis could positively impact overdose mortality:
1) People could be reducing their use of opioid analgesics, substituting medical cannabis instead to control pain. 2) People could be reducing their use of alcohol in combination with opioids, substituting medical cannabis instead. Alcohol and opiates are central nervous system depressants and the combination can be deadly. Often deaths from that combination get reported simply as opioid overdoses. 3) People could be reducing their use of other medications such as tranquillizers or anti-depressants. The combination of those drugs with opioids is a major factor in so-called opioid overdoses.
Any or all of those could be happening, and if so, the end result would definitely be a reduction in overdose mortality. The point is we don't know for sure, but there is a chance that legal access to medical cannabis is in fact helping to reduce the incidence of opioid overdose deaths. If it does prove to be true, that's yet another reason to legalize cannabis.
You can learn a lot more about overdose, about opioids, about pain management, about medical marijuana, and other related topics at my website drug war facts dot org. Visit it today.
You are listening to Century Of Lies. I'm your guest host Doug McVay, editor of Drug War Facts dot org.
I was fortunate enough last week to get an interview with Paul Armentano, the deputy director at NORML who's one of the top drug policy researcher/analysts in the nation with a focus on marijuana. We talked about a number of things including the newest marijuana-related research and various related reforms. Here's part of that conversation:
DOUG McVAY: The new one that I’ve only seen an abstract about is the new research which I think is out of the University of Buffalo about domestic partner violence in alcohol vs. marijuana. Have you had a chance to review that one?
PAUL ARMENTANO: Yes. That’s a paper that came out last week and it was put together by a team of researchers from the University of Buffalo, Rutgers University and Yale University.
What they did was they tracked 600+ newly married couples over the first 9 years of marriage. They wanted to see if there was any association with the self-reported frequency of marijuana use by either individual in these marriages and incidences of intimate partner violence. What they discovered is when they controlled for age demographics, alcohol use and a number of other factors that after controlling for those factors what remained was an inverse association between marijuana use and domestic violence. In other words, the more frequently marijuana use was reported among newly married couples the less likely they were to report incidences of intimate partner violence.
DOUG McVAY: If I recall from the abstract they said that it was especially pronounced when both partners in the relationship were users. Did I get that right?
PAUL ARMENTANO: That’s correct. That was the scenario where couples were least likely to report incidences of intimate partner violence – situations where both the husband and the wife reported using cannabis.
I would note that even though the abstract talked about this correlation associated with the more frequent use of cannabis that the couples that were surveyed in this study by in large were not habitual cannabis users - on average they used maybe once or twice per week.
DOUG McVAY: So, basically, just a thing of them hanging out with your partner on a weekend and just the general “chill out.”
PAUL ARMENTANO: Exactly and where alcohol comes into play wasn’t so much in this study but there was a previous study looking at marijuana use, alcohol use and incidences of intimate partner violence that was published by another research team back in January. That study found a very strong correlation between alcohol use, the quantity of alcohol ingested and incidences of domestic partner violence while that paper also (like this most recent paper) found an inverse correlation between use of marijuana and domestic violence and that really shouldn’t come as a surprise who has looked at this research over the years. We’ve seen for decades going back to the Schafer Commission Report documentation that cannabis is not an agent that stimulates or fuels violent behavior or aggressive behavior whereas we see that alcohol is a contributing factor to both aggressive behavior as well as victimization.
DOUG McVAY: It’s one of those things that ...I mean, we have to have the research to show it. You do have to have something to prove it because ultimately you are going to be challenged to do so especially when you are talking policy and yet it seems like such a given. Violence and alcohol use...well, yeah. You see it all the time. You hear about it. I grew up in a working class town in the Midwest and that was just a fact of life and, yet, we do have to have the research to support it.
PAUL ARMENTANO: We most certainly do have the research and what’s ironic about this paper is you and I might have this discussion and say, “Well, it ought to self-evident that alcohol fuels violence and marijuana does not fuel aggressive behavior.”
But keep in mind this study was funded in large part by NIDA (the US National Institute on Drug Abuse) and it is part of a multi-year grant where NIDA is focusing on drug use and incidences of domestic violence and whereas you and I may have presumed that researchers would come to this conclusion if you look at the initial protocol and the motivation for NIDA providing money for this study the researchers’ hypothesis was just the opposite – they presumed that they were going to find a positive correlation between marijuana use and domestic violence and were surprised when they found the opposite results.
Again, it is key that we don’t go on presumptions but that we have the data to substantiate our positions.
DOUG McVAY: So the new research that came out in JAMA Internal Medicine, the article about opiate overdose mortality and the impact that medical cannabis laws are having. Can you tell people about it and what do you think of the research.
PAUL ARMENTANO: This is a really important study, Doug, and I’m glad to see that it is getting quite a bit of mainstream attention. In fact, as an aside, I’ve had some private correspondence with the lead researcher of this paper and he expressed to me that he was surprised to see his research getting paid so much attention and, in fact, he acknowledged that none of his prior papers had ever attracted any media attention but that, indeed, this paper was attracting a lot of media attention and it should.
What this research team did – and it was largely researchers at the University of Pennsylvania along with researchers from John Hopkins University in Baltimore – is to assess that certificate data in all 50 states for the years 1999 to 2010. They wanted to see if there were any differences in the number of deaths attributable to opiates in states that had enacted medical marijuana laws compared to states that had not. To be clear they were not just looking at deaths due to the prescription use of opiates. They were also looking at deaths due to heroin overdose and deaths due to suicide through the use of opiates.
What they found was during this 11 year period of time during which 13 states enacted medical marijuana policies that on average states with medical marijuana laws possessed a 25% reduction in opiate-related mortalities compared to the states that had not enacted such laws. Specifically they found that measurable drops in opiate-related deaths immediately after these laws were enacted.
For instance, during the first year post-medical marijuana enactment states experienced a 20% drop in opiate-related deaths. After 2 years that percentage drop was 25%. After 5 years they documented a 33% reduction in opioid-related deaths in states with medical marijuana laws.
This is especially dramatic because these reductions were occurring in these states during the same time period that opioid-related deaths nationwide were skyrocketing – rising from about 4,000 annual deaths in 1999 to over 6,500 deaths in 2010. So not only are there implications from the findings of this study in regard to the use of medical marijuana there are much broader public health implications that we can derive from this study as well.
I would be especially curious to see follow-up data published or at least additional research conducted to try and determine if individuals in these states are simply substituting cannabis as an analgesic for opiates...in other words, are fewer people in these states using opiates and is that what is attributable to this reduction of opioid-related deaths or are people in these states using cannabis adjunctively. In other words, are they using cannabis in combination with opiates and, therefore, taking lesser doses of opiates. In other words maybe we have the same number of people taking opiates in those states with medical marijuana laws but they are taking lower overall doses of opiates and is that responsible for the potential reduction.
Those are questions that can be answered if we go ahead and do the study. Clearly I think it is very important that we get more details as to what may be causing these results. The final point I want to make about this study and its implications have to do with the crafting of medical marijuana policy because clearly we see in these states a harm reduction effect when it comes to the general public’s use of opiates and we can infer that in these states chronic pain patients are using cannabis as an analgesic agent and they are using it safely.
That is important when we factor in the reality that in recent years there have been lawmakers in a handful of states that while they have moved forward with the enactment of medical marijuana legalization laws they have purposely removed the use of marijuana for chronic pain as a qualifying condition. That is a public policy move that is clearly in the wrong direction. In this case it’s a public policy decision that is flying directly in the face of what the science tells us are what would be the ideal way for medical marijuana to have a foothold as a therapy.
Clearly marijuana or arguably marijuana’s greatest therapeutic effect for both efficacy and for the safety of the patient is in the treatment of pain. That is one of the implications of this study. Therefore it makes no sense from a public policy standpoint to exclude chronic pain patients from having access to cannabis as some of these newer policies have tried to do.
DOUG McVAY: Tell us how to find your work.
PAUL ARMENTANO: They can go to the website for the National Organization for the Reform of Marijuana Laws, http://norml.org. Much of my reports on the breaking science I post the same day to the NORML blog which people can read on our front page. We also update multi-times a day on NORML’s Facebook page which I think is http://facebook.com/NORML
DOUG McVAY: You are listening to Century Of Lies. I'm your guest host Doug McVay, editor of Drug War Facts dot org.
That's it for this week. I'm Doug McVay and this was Century of Lies. Thank you for listening. You can find a recording of this show and past shows at the website drug truth dot net, where you can check out our other programs and subscribe to our podcasts. Follow me on Twitter, where I'm @ Drug Policy Facts and @ Doug McVay. The Drug Truth Network is on Facebook, be sure to give its page a Like, you can find Drug War Facts on Facebook as well, please give it a like and share it with friends. Spread the word. Remember: Knowledge is power.
We'll be back next week with more news and commentary on the drug war and this Century Of Lies. For now, for the drug truth network, this is Doug McVay saying so long. So long!
For the Drug Truth Network, this is Dean Becker asking you to examine our policy of Drug Prohibition.
The Century of Lies.
This show produced at Pacifica Studios at KPFT, Houston.
Transcript provided by: Jo-D Harrison of www.DrugSense.org