New research coming out of the UK, using PET scans, shows long-term a-motivational syndrome in pot smokers. We also discuss the new yearly UN drug report – showing cocaine and meth use flat, and skyrocketing use of new synthetics: spice, bath salts, etc.
Howard: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions, I am Howard La Mere. There was a story in our local paper that is emblematic of what’s going on around the country, I think and a pretty comprehensive U.N. report that just came out recently. We’re going to start with a story on research done in the U.K. on long term marijuana use and its effect on motivation and as I said when we were talking about this, amotivational, eh? that seems like “duh” to me. It’s always seemed pretty obvious that it’s amotivational, but I guess there is a difference between long term use and short term. Darryl, shed some light on this.
Darryl: Well originally, Howard, I thought this was another one of the controversial studies that have been around since the beginning of investigations on marijuana and the potential problems associated with its use. Since the 1930’s, there has been talk about amotivational syndrome and how smoking marijuana causes it – but information from other reports… specifically Jamaican farm labor reports found that farm laborers who smoked marijuana were more productive than farm laborers who didn’t, so according to those studies marijuana was a motivational substance. This controversy has gone back and forth for several decades. I think what’s new about this new study, done by Dr. Michael Bloomberg..excuse me, Dr. Michael Bloomfield and associates at the Institute of Clinical Sciences at Imperial College of London in the United Kingdom, was that they used PET scans. And I’m not sure anybody used PET scans before to settle this controversy on whether or not marijuana can cause amotivational syndrome. And what they noted was.I should mention here, that it was a very small studya total of 38 people, 19half of them were chronic marijuana smokers who were compared to people of the same age, same gender who were non-marijuana users. They were specifically looking at dopamine and dopamine levels in the brain. Inappropriate or higher levels of dopamine are associated with schizophrenia and thought disorders and new reports indicate that marijuana is now frequently linked to thought disorders and schizophrenia. They were trying to determine what the levels were and they came across what they thought was an unusual finding – which I don’t find unusual at allthat chronic marijuana smokers had lower levels of dopamine and therefore shouldn’t be more likely to suffer any kind of major thought disorders, whereas the nonsmokers had higher levels of dopamine. I think they forget about initial versus chronic effects of drugs on the brain and we do know that
Howard: Hang on a sec.how does dopamine level effectwhat did you say? Depression?
Darryl: No thought disorder or schizophrenia.
Howard: Oh, schizophrenia.
Darryl: And the current assumption, although it’s not always 100 percent correct – is that people with schizophrenia, also known as thought disorder, have a higher level. They’re actually on dopamine highs while they suffer the symptoms of hallucinations, hearing voices and things like that. And therefore, the medications that have been designed to treat schizophrenia or thought disorders are mostly dopamine blockers – but anything that can block excessive dopamine is able to control the symptoms of schizophrenia. So, I think that’s what they’re looking at and they are surprised to find that chronic smokers had less dopamine, but what doesn’t come to light is the initial effects of a drug on the brain and then the chronic effects of the drug on the brain. We know that dopamine is involved with every single addiction whether it’s a behavior like gambling or it’s a drug like cocaine or marijuana, the effects of the behavior or a drug like marijuana is initially going to greatly increase the release of dopamine in the nucleus accumbens and other parts of the brain than would normally occur in a person’s day to day life which may explain why some people who are smoking the new more potent marijuanas and getting involved with the spices, and the synthetic marijuana’s are suffering more schizophrenic effects. The effect of the initial dopamine release is so high, it begins to create symptoms of schizophrenia. Reports also indicate that in some people the symptoms don’t go away. They remain schizophrenic even after that initial first break. What eventually happens with chronic exposure to any addictive drug. is the person gets lower levels of dopamine. less dopamine in the brain causing them to feel out of sorts, feeling out of it, not functioning and craving the drug just to feel normal again. I think this study illustrates that long terms users of marijuana are really addicted. Just like being addicted to any other drug, there is a depletion in dopamine which results in craving and all of the behavioral characteristics that go along with addiction. So, I think this study shows that but – instead, they went on the other tracksaying “well gee, we see decreased dopamine and maybe that better explains these PET scans” because it is not just researchers watching behavior or interviews of people complaining about what’s happening to themit is a scan of the brain. Scans show chronic smokers have decreased dopamine in their brain so maybe that explains why marijuana abuse results in amotivational syndrome.the loss of motivation to do anything. I think this is still very controversial – whether it can cause motivationamotivation or not, but I definitely think we’re missing the boat by not seeing these studies as definite vindication that marijuana, like any other drug of abuse or addiction, is fully capable of producing a biological dependence just like heroin, just like cocaine, or just like benzodiazepine.
Howard: That leads us straight into the U.N. report which shows that use worldwide of cocaine and heroin is essentially flat. It hasn’t increased in the last couple of years, but what has increased is the use of designer drugs and this is causing governments around the world to struggle to cope with these new legal highs that we’ve talked about before – like spice and bath salts with names like Meow, Meow. The fact that they’re legal and governments are racing to make them illegal, and the side effects are unknown. In most cases these drugs are more powerful than what they’re designed to emulate, be it cocaine or marijuana, they are just remarkably powerful creating serious medical consequences and medical trauma. Now, Darryl, do you see anything different or specifically highlighted in this report in terms of the designer drugs or is it just a natural evolution?
Darryl: Well, I saw a few different things, Howard. I saw a validation that what we’re experiencing here in this small county in a rural state like Oregon, is pretty much the same thing that is happening all over the world. It’s just not here and it’s just not the United States, but we’re right on the cutting edge so to speak of a global drug situation as much as any other place. The United Nations office of drug and crime, released their 2013 world drug report and it contains pretty much what we’ve been talking about here on this podcast for the last 3 years or so – so maybe we’re a little bit ahead of the world situation. As you mentioned – there is a flattening out of some major drugs of abuse, but a worldwide increase in what they’re calling new psychoactive substances. In the United States use of new designer drugs like bath salts, synthetic marijuana like spice, is increasing and that is true all over the globe. Various cultures are turning on to them and finding that they’re relatively cheap compared to some of the natural products and they’re stronger. Bath salts are sometimes 4 times, 5 times stronger than the cocaine that you can buy off the street. The spice, the synthetic marijuana is up to 800 times stronger than what’s in cannabis, what’s in marijuana, so
Howard: That’s just scary. Now I don’t know if it was in this article somewhere else, but the internet is a significant part of this story. These things are sold in smoke shops, but the internet is significant in turning people onto these substances, letting them know about them and selling it to them.
Darryl: Absolutely and that was also a part of the 2013 United Nations report the internet is certainly a huge source for promoting or getting the word out about these new substances. It’s hard to imagine countries that are looked upon as backward and immersed in poverty and so lacking in the things that we take for granted here in the United States, logging on and tweeting all over the internet technology allows them to become exposed to new drugs and gain access to them by ordering off the internet. There are risks – lots of times people cheat you – saying they’ve got something and they don’t really have whatever they say they do – but the internet is definitely making this a world phenomena and not something that just happens in Oregon or happens in the United States or in Great Britain or Brazil, – it’s happening all over the world. So, that has validated what has been happening – that there is a real change in the future of drugs in the world and it’s moving towards a designer drug world. There is no way we can keep on top of these things – there are so many modifications you can do to chemicals that allow drugs to circumvent the laws. There’s no testing so there are no documented results. Someone could so something totally bizarre or even die – and there won’t be any recognizable evidence of a drug. That will now be a clue – that there is a new drug that we don’t have an analysis for we don’t know what it will do. None of these things are going to be tested to see how they affect anybody until they sell them to someone and see how the customers react to these things. So, it is a new world out there.
The other part of that report that I found interesting and also mirrors things that we see in our own back yard is the global increase of prescription drug abuse, especially prescription opiate drugs. In 2011, 2012, I think – Oregon was number 1 in the nation with per capita prescription drug diversion, prescription drug abuse, especially opiates. Our small county , Jackson County, is number 1 in Oregon, so we seem to be on the cutting edge of that situation as well.
Howard: That’s amazing.
Darryl: Our local paper, did a two day series on the prescription opiate problem right here in this county and how as we control more and more of the prescription opiates, heroin becomes more popular because it’s more available and less hassle than trying to get a hold of Vicodin or Oxycontin. So heroin becomes popular. We worked hard and with treatment efforts as well as prevention efforts and decreased the number of deaths in this county from opiates to only about 6 in the last 6 or 7 years and then all of a sudden in 2012, we shot up to 7 deaths and it seems to be on an increase.
We’ve talked before about some of the pharmaceutical firms who would like to develop more powerful opiates that don’t contain any Tylenol so patients won’t have to suffer the toxic effects to their liver if they need medication in higher doses to deal with their pain. Medications containing hydrocodone which is the main active ingredient in Vicodin – which contains 5 mg – are being proposed that would contain 80 mg. Zohydro, the name of this medication, is sixteen times more toxic and addictive than Vicodin . Like Oxycontin, the hydrocodone chemical in Zohydro would be locked up with different compounds and different plastics that would provide a slow release once it is taken orally and provide pain relief for an entire day but prevent the bonus rush of 80 mg – which is what happens when the chemical is uncoated. The rush is what provokes opiate addiction. The pharmaceutical companies say there is currently a witch hunt going on – that the problem of prescription opiate addiction is highly exaggerated and what they are trying to do is provide medications with higher doses to benefit people who are suffering needlessly from pain.
Howard: Are you talking about pharmaceutical companies?
Darryl: Yes, pharmaceutical companies who want to come out with products they can market. High dose medications containing highly addictive opiates will have a huge market. Their position is that the medication was not created for diversion or illicit purposes, but to help people who don’t have adequate pain relief and need a higher dose of medication. The goal is to provide compassionate and reliable care to people who need it but at the same time – more medical people and scientists are finding that chronic use of opiates for pain results in increased pain, not decreased pain and cause all kinds of strange things to happen so the current trend in medicine is to use fewer opiates and try alternative practices to help relieve pain. Chronic use of opiates is not a good thing and it has led to the massive problem we’re seeing all over the country. An editorial in today’s New York Times demanded that the government do more to control the run away train of prescription opiates and their diversion because the abuse is killing so many people across the United States. We’ve talked about this issue for a couple of years or more now, Howard, and to have it validated by the New York Times and by the United Nations World Health Report is – in a strange way – gratifying. That’s not a good thing to say, but it shows that we’re not living in a vacuum here and what we’re seeing is part of a global community.
Howard: It really is amazing that our area has the same issues that continue to be characterized as a runaway freight train globally. And controlling it is increasingly difficult and apparently not very effective. And of course, big pharma doesn’t want to address it – there is too much money involved.
Darryl: And in a way evokes Dr. John Newmeyer’s book (The Mother of All Gateway Drugs) that what we need is to deal with these things with a global perspective, although I personally don’t advocate this – legalize, and tax, to regulate, and then use that money to discourage through treatment or by media campaigns focusing on prevention to discourage use.
Howard: Yes, but as we’ve discussed a number of times, we see how well that works.
Darryl: RightI think the main flaw in that argument, as you point out, is can we regulate these things? And it doesn’t look like we canif there is money to be made – there’s no way to regulate. We saw reports saying that the biggest source of tobacco products and nicotine products in New York are smuggled so customers are spared the pain
Howard: Isn’t it 12 dollars a pack or something in New York?
Darryl: Yes, so customers are not paying that heavy state or federal tax – the dollars go straight into the coffers of the people who are smuggling products in.
Howard: Right.
Darryl: I don’t know what to do or how to approach it. I am very curious as to how Washington and Colorado are going to regulate their marijuana laws. They have legalized it, but now they have to regulate it. They have to put age restrictions, determine the amount that forbids driving a car or operating dangerous machinery….how are they going to regulate that stuff? And how are they going to pay for it? It’s a very curious thing how we jump into things .even when we’re able to see the potential consequences let alone the unforeseen consequences.and then try and figure out the consequences afterwards only to be chagrined that maybe we shouldn’t have done it in the first place.
Howard: Yes ….the Latin for first do no harm.the physician’s motto and I think that applies.
Darryl: I certainly learned that my first year out of school – working at the Haight Ashbury clinic we saw the overdoses and my colleague and my late great friend, Dr. George “Skip” Gay was a strong believer in primum non nocere it’s the Latin for “first do no harm” and when we were faced with all the then ” new designer drugs” similar to what we are facing today – we didn’t know what they were or what they did.he always told me primum non nocere, let’s not jump to do anything, let’s make sure that we can control all the things we see first so that we don’t do anything that might cause more harm to the patient than they are already suffering.
Howard: Right and that applies to pain medication, I think, in particular which is what we’ve been talking about and will continue to talk about, I’m sure. That’s about all the time we have for now. Thanks for listening and your comments, questions, and suggestions are always welcome. Stop by the CNS website, cnsproductions.com and leave us a note there. Darryl, thank you very much.
Darryl: Hey, thanks Howard. Have a great 4th!
Howard: Thanks! You too!
Howard: That wraps our pod for today. Thanks for visiting the CNS Podcast. Please check back soon for the next in the series and visit our website, www.cnsproductions.com