Australia’s new rules on packaging are making cigarettes taste not as good, smokers are saying. The graphic pictures of the harmful consequences of smoking was also proposed for the US, but defeated by the tobacco industry. And we discuss related issues, such as the rise in smoking right after 9/11, and other effects of stress in America. Also, a recent editorial proffered the possibility that the pilots in the recent San Francisco airliner crash may have been so focused on the onboard technology, perhaps a result of the way they are trained, that they neglected to look of the cockpit window and noticed that they were going slow, and landing short of the runway. And the idea of offering vets addiction treatment via the internet is being weighed.
Howard: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions, I am Howard La Mere. We have a long list of things to talk about today – we probably won’t get to all of them, but let’s start with a brief rundown. Gil Kerlikowske, the man in charge of drug control policies for the White House, made a statement that the phrase “war on drugs” is banished and money is now being focused on treatment and that’s good news. We wonder where the money is coming from – but it’s good news never the less. He also met with Latin American leaders and warned that legalizing drugs was no quick panacea. The FDA has approved a new drug, buprenorphine and Naloxone, a mixture of buprenorphine and Naloxone made by a Swedish company called, “Orexo”. It’s taken under the tongue and it’s minty flavored so more people will use it, I guess. The AMA has announced a new pain treatment management program as part of their continuing education for doctors treating patients with chronic pain. Online treatment for vets was also in the news – we’ll talk later about the efficacy of online treatment. And finally there was an article in today’s (July 10, 2013) New York Times about a new cigarette package labeling law that went into effect in Australia and how it seems to be having an instantaneous impact on the way smokers perceive the taste of their cigarettes. Darryl, what is your take on that?
Darryl: Well, actually there were a couple of stories about smoking that interested me this last week and that was certainly one. The second one was a recent study released by the CDC (Center for Disease Control and Prevention) on the impact of 9/11 in 2001 on smoking behaviors in the United States. But back to the Australian study – about 6 months ago, I believe, Australia enacted what was been rejected in the United States – a proposal that cigarette packages display graphic images of how cigarettes damage you, how they can cause a lot of medical problem and biological problems. We sometimes see ads on television featuring spokespersons who have amputated legs or are smoking through a hole in their throat or whatever, saying how smoking has impacted them. For 6 months now that each pack of cigarettes sold in Australia comes with a very graphic picture on the negative impact of smoking. And the surprising part is that since this was introduced, there are no numbers yet on how much of an impact it has on smoking behavior, but interviews with smokers and tobacco users find that these negative ads or these negative images on every pack of cigarettes is actually changing their perception of the taste of the cigarette. Smokers say they taste bad – not as good or weird and they’re not liking it as much. The actual cigarettes were absolutely not changed at all – the product is the same. It was the same Marlboro or the same, Kool, or whatever cigarette that was in the regular packets before. The only difference was the change on the package. That had a major impact on smokers “my gosh, this thing really changed the taste and it changed it for the worst”. They don’t like the taste of these cigarettes. So that’s an interesting phenomenon about how advertising or reverse advertising can discourage use. Maybe just by showing the negatives, the believable negative symptoms – we used to call them scare tactics – that are true and effective have an actual impact on how people perceive or how people experience the use of a substance. Even though there has been no change in the chemical properties of the product – smokers experience either a bad taste or more negative effects from use.
I do want to talk about the CDC study that measured the smoking habits of Americans like prior to 9/11/2001 as compared to 2011, 2012. And surprisingly there was a major increase. There wasn’t a decrease. Whether it’s due to the events of 9/11 – and they are projecting it is, or due to just changing trends in American’s attitudes about smoking. The study showed about a 2.3, 2.4 percent increase in smoking since 9/11 and the assumption is that 9/11 has resulted in a great amount of stress in America.
Howard: Sure.
Darryl: Simply trying to get through an airport is an example of the level of potential stress – there are all these x-ray machines or whatever they call them -I think someone could go through naked and still be called aside for “something of question” I fly a lot and the few times I was pulled aside I asked, “what caused this?” I get answers like, well maybe your pocket was too thick, or maybe there was a flap of shirt that was bent over the wrong way or something. Going through airports has become more stressful. And the recent Boston bombing illustrates it is not as peaceful to be out and about as it used to be. The thrill of being able to travel and visit new places is tinged with the fear that you might be the unlucky one that is on some plane or some train or in a store or someplace else that is targeted for some kind of major disaster. It has become a national fear. It reminds me of George Orwell’s novel, 1984 it’s our common past and we live in a society now that’s has magnified fear more than I ever thought would happen. And that process that fear brings with it a great deal of stress and we know that one of the things that nicotine and smoking habits seems to relax is stress and depression and the fact is brought out in this research. Since 2011 there has been an increase instead of the expected decrease in spite of all of our anti-smoking campaigns, all the information directed toward younger kids – we actually have an overall increase of smoking.
Howard: Do those numbers span the whole 11year period or was it just for a year in 2001?
Darryl: The study, conducted by Weill Cornell Medical College, commissioned by the Center for Disease Control , measured the whole period from 2001 until about 2011 or so. We have to remind ourselves that we were sort of winning the war in the early 2000’s at the end of the 1990’s, 1999, we were seeing a decrease in illicit drug abuse. We were seeing a decrease in alcohol use. We were seeing a decrease in tobacco use. And we were thinking we’re doing the right thing or the government was thinking they were doing the right thing in terms of the risk factors, perceptions on health and the like – but this shows an increase in tobacco use – and connecting it to the change in mood and change in attitudes and the Homeland Protection Act today we’re a much more scared society.
Howard: Conspiracy theories maintain that was one of the reasons for the attacks – to make Americans more scared and thus more easily controlled. That of course is a conspiracy theory but that doesn’t mean it’s wrong. Just because you’re paranoid doesn’t mean they’re not watching. A new theory out there is that the addiction to technology might have played a role in the recent airplane crash in San Francisco. There were several pilots – all experienced – but an editorial suggested that perhaps they were so busy looking at their computers and their instruments and punching those buttons that they neglected to look out the window – if they simply looked out the window they would have seen a wall right. I don’t know if the markers were in place that show where you’re supposed to touch down – I did see something about a runway that was missing markers because of construction – but obviously something went wrong that is hard to explain. And it brings us kind of back to the whole internet addiction and cell phone addiction, Smart phone addiction, and that is a component of addiction I think most assuredly.
Darryl: Our hearts go out to the families of the 2 women, the 2 young students who died in that plane crash. The pictures of the plane were horrific in terms of how it caught fire and burned and I think there are many who were critically injured and will perhaps be paralyzed for life. But when things like this happen you have to look at it with perspective – if you look at the pictures and hear the story, it’s sort of a miracle that the number of casualties was much less than you would expect from a horrendous crash like that. Having said that, we’ve been following the news I think everybody has, as to what happened – What went wrong – and horrific things like this are analyzed and reanalyzed and looked at from 10 million angles and the only thing we have right now are speculations. They’ve already interviewed the pilots and one of the things, as you said, that came out was the reliance on the auto accelerators and the auto landing processes that didn’t seem to be occurring in San Francisco – I’ve heard many pilots speak about this from all over the country – one said ” oh sure there are auto landing things and auto accelerators, but 95% or 99% of pilots don’t pay attention to them. They’d rather do it themselves.”
Howard: Right.
Darryl: We have to remember how they’re trained now. They spend hours and hours in flight simulators experiencing many kinds of situations but the consensus is that a human’s ability is not as good as the mechanical. And the other part of the story I don’t know if it’s confirmed or not, is that the pilot was a fairly young and it might have been only his first or second time into San Francisco airport.
Howard: No, no it was his first time into San Francisco, but he was a very experienced pilot flying 747’s for hundreds and hundreds of hours.
Darryl: But the thing is because he is young – his training may have been very different than the seasoned pilots who were commenting on the news. His training was to look at these instruments, rely on them. The only other crash of a 747 was in .where was it it was in Canada or British Columbia or England? I think it was at Heathrow, in England. The plane crashed in much the same way – it is one of the safest planes in the air and when they investigated the crash they found ice had accumulated in the fuel connection and although it had auto acceleration, it couldn’t accelerate and crashed. I really hate to speculate on this recent crash because there are still a lot of questions. But I think your comment about is the individual at fault because of a reliance on computers and on technical systems or is it really how we’re evolving as a culture and as a people is this a world view?
Howard: Definitely the latter.
Darryl: If you travel to other cultures – the most desperate, the most deprived, the poorest culture in the world and they’ve all got cell phones and they’ve got computers! You wonder how that is happening! I’m sure the companies who manufacture this technology make it available everywhere to get more and more people, as you say, addicted to them and reliant on them in daily life. It’s very annoying -but frequently when you are out to dinner or out for a night with friends and someone asks a simple question like “who wrote that song” and everybody pulls out their cell phones and connects to the internet to look it up you know, I think there’s something wrong about that and I think you are right, there is a greater dependency on it – does it have the potential to cause tragedies like this? I think there is great potential – we haven’t even talked about the potential to be hacked ……somebody hacking into the system at just the right time, on 9/11 it was the pilots who took over, but if pilots are so reliant on technology, the terrorists won’t even have to train them. ..they just have to hack into the systems, hack into the aircraft and direct it to crash, if you know what I mean. So, it is a concern for sure. But this was, I think, related to another story about – treatment…for veterans online. The program allows vets to access the CSAT, Center for Substance Abuse Treatment, our old friend, Dr. Wesley Clark is the director of that agency. They have developed a whole range of online treatment and counseling systems and group systems for addiction. Even though they charge for these programs they are so much more economical than paying for a one hour individual session or a group session, plus you have to physically go to the sessions. Participation in these online sessions costs about a quarter of the price someone would have to pay for in person treatment. The first part of the treatment is an online self assessment, evaluation, if you are a veteran, it is free of charge. Because it is being offered by CSAT, Office of Substance Abuse Treatment, that means that they had to do a lot of research to show that evidence based wise it is effective and does what it is designed to so – and if that is the case why aren’t we offering this to everyone for free? We’re concerned we’ve got this drug war, the government says treatment is a good thing, but yet, we’re going to charge you to go online and begin to look at yourself and your problems that doesn’t make any sense to me.
Howard: Right. I guess it’s all about the money.
Darryl: Unfortunately, even when it’s our government, I guess especially that it’s our government that, yep it’s all about the money. We’re going to have to pay for this.
Howard: Now, we’re almost out of time but let’s talk briefly about the bath salts there was a report, highlighting in greater detail, and I think with more evidence, the power of these new designer drugs.
Darryl: Well, there were so many interesting things to talk about this week …. I got really excited at the beginning of the show, and I guess we kind of overran our talk time again as usual. I don’t think you mentioned bath salts I think they’re calling them internationally new psychoactive substances, which is the group that includes bath salts and spices and all the new opiates, – the synthetics. A major study was conducted on the first major bath salts the pyrovalerone bath salts, methylenedioxypyrovalerone, MDPV, which is now banned and illegal. The Scripps Research Institute did tests on lab rats – a practice some people object to but it is important to understand that rats have 90% of the same genes humans do and get addicted to the same drugs human get addicted to .the testing involved observing how many times the rats would press a lever to gain to access a drug rather than eating or than having sex or anything else, they found rats to the lever for MDPV more often than they did for methamphetamine. Sixty presses for a dose of meth vs. 600 for MDPV. This supports what the kids were telling us – that bath salts are stronger than meth. After MDPV became illegal, there are now about 40 or 50 others out there and every time one is made illegal, another one pops up, and this is something that’s going to continue. Stronger and stronger chemicals are able to have the same effect – a more intense effect than methamphetamine and cocaine deliver which is a scary thing because we all know the dangers of too much methamphetamine or cocaine. That story is going to continue and now these is research that says yes indeed, these things are stronger than what’s out there.
Sort of similar to that was news about the return to a favored drug by club druggers and designer druggers, that drug is “ecstasy. ” There are new products on the street called, “extreme ecstasy” or “meth X” . Producers are adding methamphetamine to it. When we used to test for it at raves and clubs and places like that, we used to find occasionally that the pills were already adulterated with methamphetamine but we always thought it was an accidental process – that somebody was trying to convert methamphetamine to ecstasy and they didn’t quite get a real clean process so there was leftover methamphetamine. But now what’s being done is an intentional, intentional addition of a good amount of methamphetamine to give ecstasy even more power and maybe make it more addicting and maybe people more reliant on it. So, there are these continuous stories about what we call, new pharmaceutical products or changes in older pharmaceutical products, but again, remind our audience here that no matter what the street chemists come up with, it’s going to affect the brain in 1 of 3 ways, Howard. I hate to promote our book, but every drug is either an Upper, a Downer, or an All-arounder and they all have various strengths and if you keep in mind what you’re dealing with and how you have to interact with it and what people are going to be faced with so you know how to treat it. So, that’s the whole designer thing that’s happening and this is just tip of the iceberg.
The other thing that you wanted to talk about was the study showing that prescription drug abuse, especially prescription opiates, has increased 400% in the last decade ..excuse me, I meant to say… the deaths from prescription opiates have increased up to 400% in women. That validates what has become an epidemic here – prescription opiate abuse in America. Despite that, we still continue to get push back from pharmaceutical companies who recognize that addiction sells, addiction makes money and so the FDA approved yet another opiate treatment product, the same one that we’ve always had – Suboxone, which surprisingly generated in 2012 something like 1.3 billion dollars in revenue for Reckitt Benckiser – and now a Swedish company wants to jump in on the act and they’ve produced a different formulation that is a dissolvable, sublingual tablet that benefits the patient because less is required to achieve the same effect. Suboxone is now the number 1 prescription drug .opiate prescription drug in America, surpassing methadone which has been number 1 for years.
Howard: Well, given the epidemic, it’s good to have this kind of a drug available. And with that, I guess we should wrap it up. There were a lot of things to talk about this week and we’ll continue to keep our fingers on the pulse and share what we find. Thanks for listening and your comments, questions, suggestions are always welcome. Stop by the website, cnsproductions.com and leave us a note there. Thanks, Darryl.
Darryl: Hey, thanks Howard!
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