President Obama has laid out plans for mapping the brain — much like the human genome project of the 90s. Also more on opioids addiction – how it relates to treating pain. Canada now has a higher per capita rate of opioids addiction than the US, with Denmark coming in third. And the logic, fairness, or lack thereof of tying drug testing to welfare assistance. PODCAST.
Howard: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions, I am Howard La Mere. One story I’d like to talk about is from Huffington Post/Canada which talks about the opioid addiction phenomenon which is a problem across the world, but especially in the northern hemisphere. The headline is “Opioids Not in the Society’s Margins”. I thought it was interesting in particular the ordering of Canada above the U.S. and a distant third is Denmark. So, we can make of that what we will. One of the things we didn’t get a chance to talk to last week was President Obama’s initiative towards more significant brain mapping – so Darryl, what do we know about this?
Darryl: Well, it’s actually fascinating and very inspiring to me that this is happening, but it comes at a time when our government – both houses and both the democrats and republicans are trying desperately to lower our deficit and to bring spending under control. President Obama announced his budget recently and according to our local paper, it angered both the democrats and republicans because favorite programs or areas are being cut or some things are being funded that politicians don’t think should be. There was a news item in early April announcing Obama was going to invest money into mapping the human brain and in his usual very eloquent fashion, he defended the need to do that as a society, saying we know more about the stars in the universe and galaxies, moons and other planets than we know about the 3 pound mass of matter that sits on top of our head that makes us totally different from every other creature on this planet, that gives us our evolutionary edge if you will, or gives us our species edge and gives us our ability think, create, reason – and all the other things that humans the hominids are endowed with because we have a neocortex. So it was time to invest money into mapping out the whole human brain, looking at every cell, every structure to see what it correlates to so that we may, at some time, be able to cure schizophrenia, cure posttraumatic stress phenomenon, and cure a myriad of conditions that human beings suffer from – illnesses that effect their mental state more so than their physical body. Of course addiction is a major condition and once the new DMS5 comes out in May, people are projecting that 47% of the U.S. population will now meet clinical diagnostic criteria for addictive disease. And so, by mapping out the brain and getting on top of all these things, we may find better ways of treating and better ways of preventing these conditions. I find it interesting because way back, 1989, somebody I greatly admire, Dr. Louis Judd, promoted the idea of diverting funding to better understanding the brain. In 1989, he spoke before both houses of congress and then President George H. W. Bush, urging them to act to create the decade of the brain, the decade of the mind. He was rewarded for that in terms of what he was trying to achieve within about 7 years, by 1996, 97, a bill was passed by Congress and signed by then President Bill Clinton that created the Mental Health Parody Act of the late 1990’s in direct respond to the research discovered during the decade of the brain. It was learned that mental illness, depression, schizophrenia, bipolar disease, and hundreds of varieties of mental disease were not a matter of someone’s actions or choice, or irresponsibility but a matter of biology and physiology. A true physical process or physical anomaly of the brain in which can be mapped out and seen. And that eventually led to then President George W. Bush signing the Mental Health Parody and the Addiction Equity Act of 2008, making addiction a true biological illness that must be treated as a true biological illness. So this was an important achievement by Lou and he should be given lots of the credit for making that happen. I think President Obama is correct in pointing out that our society, legislators, and scientists must not think that we’re done because the work that was done in the late 90’s barely scratched the surface of how the brain works and how the mind works and all the conditions and disorders that affect Americans and people all over the world. Obama pledged something like 250 million. I don’t remember what the exact amount was toward that, but according to this very, very tight budget he announced just this week, he wants money spent on mapping the brain. He pointed out that we did the same thing when we learned about DNA and we wanted to map the human genome.
Howard: I was going to ask the relationship between the geno project.
Darryl: Well, as Obama pointed it out, that by investing money into mapping the human genome and then accounting for that money and then looking at the financial benefits that we got by understanding the human genome, our society actually made 140 dollars for every dollar invested and he sees that economic potential in mapping the human brain. Understanding the human brain will lead to benefits that will save us money and earn us more dollars than we invest. So I’m wholeheartedly accepting this, wholeheartedly backing it, inspired by it. But there are already editorials and even fellow democrats are very upset and annoyed by President Obama’s budget. So how this is all going to shake out, I don’t know. But I do agree that it’s time that we start investing more research money and more understanding into things that impact more of our people and cost us more dollars than the things that we are currently investing in.
Howard: There is that ongoing question of what is the best use of funds and what is the proper role of government in this context. So, this sounds like a proper role for government to play more so than a lot of things that the government seems to have gotten involved in lately. So we will see where this goes. What else do we have?
Darryl: The article you first mentioned, Howard, Canadian abuse of opiates now surpassing Americans and I imagine that was reported on a per capita basis. I’m not sure of absolute numbers or the quantity of opiates prescribed or the number of addicts Canada has surpassed America in, but in terms of per capita, I’m sure they have. And it doesn’t come as a surprise to me, Howard. Canada does things very differently than we do in this country and it always amused me when I went to Canada that many Canadian citizens I meet believe they should be able to vote in the American elections because what America does has so much of an impact on what they do there and they want to make sure they move things in a different direction. But in this regard, it’s not a good situation because Canada has been a much more compassionate country in terms of treating pain and more liberal and less restrictive on things like opiate prescriptions which in some ways is very good and very humane and provides their patients the best opportunity to get relief for their conditions. But in another sense it totally disregards the addiction potential and doesn’t accept that addicts are not happy addicted to their drugs. They’re miserable and if they get into treatment and better situations, they would be far better off. So, Canada moved toward a more compassionate view of pain and is offering more accessibility to these opiate pain killers. They also moved more toward a behavioral orientation to addiction – that addiction is really a learned behavior and if addicts could gain the willpower not to abuse the drugs that they are addicted to just through education – how to use medications or how to better understanding and manage their life situations. Well, to me that approach was a disaster for things like prescription misuse, prescription overuse, since there are fewer restrictions in Canada, it’s not surprising that they have more opiate addicts. Now, how they handle that is going to be interesting. You know, Canada does things differently. I’m really hoping that they start paying attention to the research and show this country that you can invest in the treatment of addicts. With treatment addicts can get off the drugs and do better and there are alternatives to pain. Current research shows that higher doses of opiates used to treat a patient’s pain the greater the pain becomes. So pain must be treated it in alternative ways to help individuals overcome their pain and prevent them from becoming opiate addicts – so, it didn’t surprise me. I’m sure they have a greater per capita incidence and I hope that some good comes out of it. I hope they wake up and take a different look at their prescribing habits and their use of opiate pain killers and also their belief and their understanding and their interaction with the condition of addiction.
Howard: Somewhat related, another story coming out of Huffington Post here drug testing bills are proliferating across state legislatures. Not very good strategy as far as I’m concerned in terms of targeting people on assistance or whatever we call welfare and making them into second class citizens by requiring them to pee in a cup to justify receiving aid. We’ve talked before about the frequency of false negatives and false positives so I’m not sure testing serves much value. Darryl, any comments on that?
Darryl: Well I think Indiana just announced that they’ve introduced a bill.
Howard: In Texas too.
Darryl: In Texas well, some states have already introduced a bill to test welfare recipients to identify whether or not they’re an addict or non-addict. Now it could have some positive background and that positive background is the thing we talked about before that’s called SBIRT screening brief intervention referral and treatment. Much of the research on SBIRT initiatives involve imbedding questions about your drug use into applications for a driver’s license or a health questionnaire used to apply for medical benefits. this helps to identify people with potential drug use problems, assess those people, and when needed, gets them into treatment; but does not prohibit them from receiving the benefits that are being portrayed, but to get people who need it into treatment.
Howard: That presumes that we have treatments.
Darryl: That’s one of the big issues, absolutely Howard, because we still have a big treatment gap – only 1 out of 26 people who need or want treatment for addiction can access it. If these initiatives are going to save money, that money should be put into treatment. But what it speaks to is the fact that we can help people if we identify them early enough so that just a brief intervention, just some education about the potentials of drinking 6 drinks a day versus 2 drinks a day – what benefits are reaped from moderation – or the consequences of smoking or whatever. This SBIRT initiative is resulting in a startling decrease 50 to 75% in drug problem and drug use just from screening and a brief education intervention and referring to more intensive treatment those people who need it. Now if the testing is sued for that – and the funds go into that activity then it makes sense, but if it is just a punitive measure – used as a witch hunt to identify people in order to exclude them from getting assistance then that’s not a good situation. I think you’re more skeptical than I am, but I’m a pretty skeptical guy.a skeptic person rather, and I think you’re right, Howard. I think more of this initiative is generated by “let’s identify these losers and get them out we’re not going to spend a dime supporting their loser lifestyles” and an attitude that addiction is an evil or moralistic condition. There wasn’t much in the news this week but I did see a brief mention of designer drugs – I want to again validate that we’re never going to be on top of the designer drugs that the street pharmacologists are making and there is a Fox News article that mentions the availability in the United States and Britain of a new designer drug that people can access on the internet called Benzo Fury. I don’t know how it got the name Benzo Fury as a street name, but I found it interesting when I looked it up to see what it was – Benzo Fury can be either 6 APB, amino propobenzofuron, that’s one of the names for it, or the oxygen can be moved to a different position and it can be a 5 APB. It’s like ecstasy. It’s exactly like ecstasy is methylenedioxymethamphetamine, MDMA. What they did, is they just took one oxygen out of the side ring so it’s not a methylenedioxy, but maybe a methylene mono oxidated isopropylamine, very much like ecstasy but is not banned under current law – although some would say that it falls under the designer drug laws. It’s available on the internet. It’s growing in abuse all over the United States and in England, and basically it’s a spin-off on ecstasy, so it’s an amphetamine stimulant that also has psychedelic and a sort of delerent properties to it. This could be a big problem unless the government reacts a lot quicker than they have on other things, but we will see if that happens. This is again a validation that street chemists can keep one step above all of our laws and continue to do this.
Howard: I’m glad you brought that up because I did want to talk about that. Well that’s about all the time we have this week – one final note here, in our continuing list of strange addictions, someone in England, Olive White, I think, is addict to Ramen noodles and is 18 years old now and apparently has eaten only Ramen noodles for like 7 years. So, go figure! Darryl, thanks.
Darryl: Hey, thank you Howard.
Howard: That wraps our pod for today. Thanks for visiting the CNS Podcast. Drop us a note on the website with suggestions, comments or questions and please check back soon for the next in the series. www.cnsproductions.com