A look back at changes and trends that happened in 2012, and want 2013 might hold might hold in drug and addiction issues and treatment. Some of these include the continuing stories of the new synthetics, aka bath salts, incense and potpourri, also the continued increase in heroin use as pharmaceuticals become more costly and harder to get. And where are we in the evolution of treatment?
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Transcript (edited):
HOWARD: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions, I am Howard La Mere. Happy New Year! It’s 2013 and there are a variety of stories, but let’s so look at trends here where we’ve been and where we’re going. Is there anything along those lines that you want to speak to?
DARRYL: I think clearly a trend that has been established is the growth of synthetics, the bath salts and bath salt type drugs, sodas, jewelry cleaners, as well as the synthetic marijuana that is now sold as potpourri and aroma therapy or something else. This is going to continue and I think keep ahead of our ability to legislate against them and to do research in the biological system. I noticed just recently that Florida added an additional 22 synthetic cathinone derivatives or the stimulant derivatives – these are sold as bath salts and synthetic marijuanas, the synthetic cannabinoids. They’ve added 22 combinations of some of those to their list of banned substances and although they are great at trying to keep on top of it, it is important to point out that there are over a hundred substances that act as synthetic marijuana out there already and a number of different bath salt chemicals or stimulant chemicals. So, that’s a trend we’re going to continue to see.
Also there are more and more reports from all over the nation, especially rural counties – in Kentucky, and here in Oregon, of a rise in the use of opiates – especially heroin because it is more expensive to get the pharmaceutical Oxycontin and Vicodin or the generics. Also the makers of Oxycontin made it harder to abuse by injection in 2010 – that didn’t stop some addicts from figuring out how to inject it anyway, but a lot of addicts said – what the heck, heroin is more available, it’s cheaper, so they moved over to heroin. We seem to be headed toward a downer epidemic with heroin and the opiates leading the way, moving maybe away from the synthetic opiates and more into heroin.
In terms of trends, I am sad to say, I don’t see any efforts being made to do much about addiction in our communities. Efforts have remained stagnant or have decreased. I’ve recently learned that the Office of National Drug Control Policy no longer holds a cabinet position – this happened when President Barack Obama took office and it stunned me. This certainly sheds some light on why there hasn’t been a lot of movement in terms of interventions and drug treatment in this country. Things are status quo while we watch an eroding number of service providers, and fewer people with the economic ability to provide treatment. That’s a trend that I do not like to see.
I’ve been trying to get a read on the budgets from the Office of National Drug Control Policy to see what kind of monies have been appropriated by Congress or by the president to fund both demand reduction and treatment and prevention and it looks to me, without knowing the exact details right now, that prevention might have been zeroed out – that there are no funds for prevention. So in 2009 when the drug czar got all upset at Oregon and California because of the rise in marijuana illicit drug abuse for the first time in a decade – there was blame directed at the states for being so lax about marijuana and promoting a confusing position on medical marijuana. I think if you look at the funding for prevention in 2009 and beyond, efforts at prevention have greatly decreased and the result has been a vast increase in illicit drug abuse all across our country. If that trend continues, I don’t know what the solution is. Maybe it’s going to be solved by the affordable care act – that Medicare and Medicaid will now provide monies as Oregon does through its Medicaid program. A recent report that came out in USA Today said that Oregon has good efforts to treat drug abuse and are experiencing good results as compared to Kentucky because we, in Oregon, fund it through our Medicaid program whereas Kentucky does not and the results are not very positive. Many of the institutions that used to provide treatment are not provided with the resources to do this work. This is a nasty trend that I foresee.
Another thing that struck me recently in the news was a report in Biological Psychiatry and one from Medscape Medical News and a couple of other services, that there’s been a development in Columbia to treat cocaine addiction effectively with a combination of new medical drugs – and one was called the psychostimulant combined with an antidepressant – that appears to be twice as effective in helping people remain clean from cocaine for at least 3 weeks as compared to a placebo or no treatment at all. As promising as that sounds Howard, the combination of the drugs – the psychostimulant is actually amphetamine – but now it is identified as a psychostimulant instead of what it is- speed. It basically produces the same result as cocaine but the claim is when it is combined with topiramate it is effective. This strikes me as funny because – sure – if you give somebody the drug they’re addicted to or a drug that acts like it – in this case its amphetamine instead of cocaine many are not going to need cocaine
HOWARD: Because it’s almost the same thing!
DARRYL: Yes, it’s exactly the same thing and so I look at this report as funny and the development of these drugs funny and then think maybe this is a sort of backdoor approach to a trend that’s also happening in the addiction treatment field and that’s the move toward replacement therapy – making replacement therapy more in the mainstream of acceptable treatment for addictions. We certainly have established that with methadone as replacement treatment for opiate addiction and now Suboxone as a replacement treatment for both methadone and other opiates like heroin. Both seem to have good results. Maybe there is a need for medicine to move into the stimulant treatment field – and it is being accomplished by naming something psychostimulant instead of methamphetamine or amphetamine and combining it with maybe an antidepressant. However, I question the wisdom of that. So, it looks like just a backdoor approach of promoting another replacement thing and I’m not sure that’s an overall good thing to accomplish.
HOWARD: Well, there seems to be a lot of replacements, as you say, in the medical news today. Another story reported that electrically stimulating the brain produces strong opiate like pain killer reaction. There is another potential treatment option …sounds a little scary on the face of it though.
DARRYL: Well, we’ve always known that, Howard. And it makes more sense to me. If we can tap into our natural neurochemicals, our natural neurotransmitters that the opiates, and cocaine or marijuana replicates, it is a much sounder approach. It’s a more natural approach and the body has a tendency to rebalance itself when it’s within its own natural system rather than when it is given a synthetic or a substitute substance to react to. There was the story of the high school senior in Portland who is a national finalist for a science award. His mother was injured and she refused to take opiates relying instead on her spirituality to deal with the pain – he found that remarkable and he researched the use of a person’s natural systems – the natural endocannabinoids, and how to stimulate those the endorphin producing areas of brain with electrodes to release the necessary chemicals that would act as effective pain killer. That makes sense to me, but combing amphetamine with topiramate to treat cocaine addiction or amphetamine addiction doesn’t. It just sounds like another synthetic replacement therapy. Not to say that they’re not any good, but I’m just saying we have to look at what we’re doing and we have to realize what the results show and the results in that case indicate that if you give somebody amphetamine with topiramate they won’t use cocaine or they’re less likely to use cocaine while they’re on that treatment than someone in the controll group who is not getting that treatment. I don’t know if that’s good science. It’s moving toward more medicalization – an increase in the perception of addiction from a medical perspective, which is overall what we wanted all of society to do for a very, very long time. But some medical approaches are sound, but some I really think we should question in terms of what we’re trying to do for people who are suffering from this condition.
HOWARD: Yes, and you know, that approach involves the big pharmaceutical companies. Those are profit making entities and it’s routinely a matter of wanting to do good work but keeping the bottom line in mind.
DARRYL: Another story mentioned that Great Britain is now considering legalizing marijuana – the more I think about that, – I’d probably have to invest in Purdue Pharma or others.
HOWARD: Yes, absolutely!
DARRYL: Or GlaxoSmithKlein or Ely Lilly because I know they’re going to get behind that and they’re going to take it to a far more advantageous position than a kid out there growing pot in his backyard.
HOWARD: Yes, the tobacco and alcohol companies, of course, are very interested in the legalization of marijuana – giving them a new substance to sell.
DARRYL: And they have what’s the right term – they have a reliable customer base, I should say anything that’s addictive, legal or illegal, creates a reliable customer base. And if it is played correctly like the tobacco industry did in the early years – it is a guaranteed 10% increase in sales every year.
HOWARD: That’s just a brief glimpse at some of the things that we have talked about and will be talking about – a beginning of the year/end of the year overview. Darryl, closing thoughts?
DARRYL: I just want to wish you and everybody a Happy New Year. I sure am looking forward to this new year. I think it’s going to be exciting, but I’m curious as to see what the administration is going to do about substance abuse as it relates to the affordable care act. If they’re cutting out all the monies for substance abuse and don’t replace it for the resources for prevention, treatment, and even supply reduction – I don’t know where we’re going to end up with drug addiction.
HOWARD: We’re going to continue to grapple with the deficit issue, so, but as so much of the research proves – every 1 dollar spent saves 7 dollars in related treatment/incarceration costs. That wraps our pod for today. Thanks for listening and check back soon for the next in the series and visit our website, www.cnsproductions.com