Giving a Damn

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Health Care Professionals and Families Must Focus on Youth Substance Use Prevention

The peer-reviewed journal JAMA Network Open asked Robert L. DuPont, MD and Caroline DuPont, MD, President and Vice President, respectively, of IBH, to respond to a new research study by Bertha K. Madras, et al., "Associations of parental marijuana use with offspring marijuana, tobacco, and alcohol use and opioid misuse."In their commentary, Drs. DuPont note that this study showed that when parents used marijuana, their children had increased risk of using marijuana too. "This underscores the need for engagement by both parents and health care professionals in youth substance use prevention and parental substance use disorder treatment." Drs. DuPont then connect the findings to IBH's own youth prevention work:The association of parent use of marijuana with offspring use of marijuana and tobacco complements a recent finding suggesting that there is a common liability for substance use among adolescents. Among young people aged 12 to 17 years, the use of one substance is positively associated with the use of others, and non-use of any one substance is positively associated with non-use of others. There is also evidence that there is a large and steadily increasing number of American youth who do not use any substances, including alcohol, tobacco, or marijuana. More than half (52%) of high school seniors have not used any substance in the past month and more than one-quarter (26%) have not used any substance in their lifetime, up from lows in 1982 of 16% and 3%, respectively. Together, these facts can empower parents when they are educated about their own substance use choices affecting the risks of their children using substances. They can also inform health care professionals that no use of alcohol, nicotine, marijuana, or other drugs is not only the health standard for youth but that non-use by young patients is common and achievable. This commentary extends the work of IBH to set a new health standard for youth prevention of One Choice: no use of any alcohol, nicotine, marijuana or other drugs by youth under age 21. Drs. DuPont and the IBH team thank Madras, et al. for their important contribution in JAMA Network Open and thank the journal for the opportunity to share their insights on its implications for prevention and treatment.

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Is, simply, good. Very good, in fact. It is a deep-dive through the superficial fun of a party drug that 1 million Britons take into the brutality beneath. It manages to be compelling, honest and unpreachy, and treats its subject with robust respect. They visit the slums and the tenants they control, meet the children who have an 80% chance of being recruited into the industry, and go out on patrol with the navy to understand the virtual impossibility of breaking the stranglehold of the cartels…PARTY ON!  

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“Legalizing cannabis will reduce crime and raise Tax revenue – All savings will come from reduced policing, lower crime rate, less supply reduction costs, and increased tax-revenue from licensing!”

So pealed the  promises to the unwitting population from the addiction for profit advocates! Well, as the following (and little broadcasted) data reveals, the cannabis chaos continues to unfold in California (and other states). It does not augur well the future of this always clearly ‘bad idea’!  Outside of the emerging ‘medicinal cannabis’ market, Australia currently has one market for marijuana – the illegal market (Black Market). We most definitely do not need this three market ‘circus’ – Legal, Black and Grey Market and the ballooning costs both fiscally and health wise, these will bring.

‘In regards to illegal Cannabis grows, they are getting worse, not better. One of the things I promoted over two years ago, when I got involved with the issue of cannabis policy, was to address the issue as we move from the illegal to a legal market, that we have to hold accountable those that are not participating in the legal market. Particularly those that are continuing to profit of illegal grows now are manifesting they’re getting bigger and becoming more stubborn, more acute. They are not just issues for environment, of an environmental concern, but increasingly of fire safety itself. So, there is a direct correlation again between our fire preparedness and our fire safety, in addition to addressing – mitigating ah [sic], the Cartel activity that persists up north…” (February 11th 2019 Press Conference)

“Stepped-up enforcement comes with a certain measure of irony — legalization was meant to open a new chapter for the state, free from the legacy of heavy policing and incarceration for minor infractions. Instead, there are new calls for a crackdown on illegal selling…But no other state has an illegal market on the scale of California’s, and those illicit sales are cannibalizing the revenue of licensed businesses and in some cases, experts say, forcing them out of business.

‘Getting Worse, Not Better’: Illegal Pot Market Booming in California Despite Legalization (NY Times 27/4/2019)

California Department of Finance – Office of State Audits & Evaluations.

  • Even with a thriving illegal market in California, only 15 enforcement unit staff positions have been filled, though 68 were authorized. "The bureau's ability to process complaints, perform inspections and investigations and review ... testing laboratories is severely impacted," auditors wrote.
  • The three agencies that regulate marijuana need to do a better job communicating. "Enforcement unit staff stated a central contact from the other licensing authorities has not been established," the report found.
  • There's a cash shortage. The primary source of revenue for the agency is from application and license fees. About $200 million was expected to come in through June 30, 2019, but the bureau has collected only $2 million as of January 2019.

California Cannabis Regulators Struggle With Job, Audit Shows

During fiscal years 2016-17 and 2017-18, cannabis program expenditures totalled $6,774,577 and $14,876,055, with revenue received of $0 and $1,092,250, respectively. Due to the program’s infancy and initial establishment of its structural foundation, the Bureau has incurred expenditures higher than revenue.

Bureau of Cannabis Control – California Department of Consumer Affairs Performance Audit

Lissten to Audio File

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But maintaining this difference between a functioning addict and a regular addict can be harmful to a person who truly struggles with a substance addiction. The term can act as a barrier to someone deciding to get help. If my drinking or drug use isn’t causing too much harm, and if we’re all casually joking about it, is it really that big of a problem?

The “functioning addict” idea can indeed fuel a lot of delusion. I used to convince myself opiates were performance enhancing for me to the extent I would look down judgmentally on colleagues who drank alcohol at lunch—“Don’t they consider the impact that will have on their work!?” Meanwhile, I’d just been taking heroin in the toilet.

A substance may be functional at first in the sense that it helps you cope. But the addiction is papering over the problem, which is growing and growing all the while. That’s partly why it can be so terrifying to quit—you are confronted with all the problems you tried to escape in the first place, many magnitudes greater by now, with your self-esteem in tatters. From this stems the belief “I can’t cope without it.”

Finally, all aspects of my life spiraled out of control. My performance plummeted, and progressive dysfunction set in…. Sometimes people cling to a romanticized idea of the functioning addict, the creative genius, etc. But the reality is most people’s output slides in quantity and quality as their addiction progresses.

An addict may be “functioning,” but at what cost? What cost to their physical and mental well-being, to their social and professional life, to the well-being of their family?

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