DALGARNO RESEARCH REPORTS
Dalgarno Institute Research Reports are a great resource that aims to provide current research to users. The reports take key up-to-date evidence-based data relating to Alcohol and Other Drug issues and deliver it in a format that is easier to use for reference purposes. The data may have some commentary, but is generally representative of source evidence, whilst culling the extraneous. All data in the reports is referenced and cited so as to enable the user to further investigate the topic/issue if required.
Check out the complete collection of Research Papers and other useful material visit Dalgarno Institute Website
Early Onset Teen Drinking & Future Harms
Hospitalizations and Deaths Associated with EVALI (Vaping/E-Cigarettes)
As of January 7, 2020, a total of 2558 hospitalized patients with nonfatal cases and 60 patients with fatal cases of e-cigarette, or vaping, product use–associated lung injury (EVALI) had been reported to the Centers for Disease Control and Prevention (CDC).
CONCLUSIONS: Chronic conditions, including cardiac and respiratory diseases and mental health conditions, were common among hospitalized patients with EVALI.
- Ken C. Winters (Ph.D. is a Senior Scientist at the Oregon Research Institute )
Marijuana Effects on the Endocrine and Reproductive Systems
Scientists Study How Alcohol and Cannabis Affect Adolescent Brain Responses
Executive attention and response control are critical for impulse control. Both rely on regions at the front of the brain like dorsolateral and dorsomedial frontal cortex regions. A recent Boys Town study has indicated that adolescents reporting more abuse symptoms, particularly those associated with alcohol, show problems using these brain areas during response control. Scientists note that if these regions aren't working well, an individual is less likely to control his/her impulses and may be more likely to abuse substances in the future. In addition, behavior generally becomes more impulsive.
Cannabis Genotoxicity Chromothripsis Carcinogenicity and Fetotoxicity MR FMMM
Conditional probabilities of substance use disorders and associated risk factors: Progression from first use to use disorder on alcohol, cannabis, stimulants, sedatives and opioids
- • Pre-existing mental disorders increases the risk of developing SUD.
- • Prior SUD increases the risk of transitioning from use to use disorder.
- • Highest rates of transition to SUD occurred among stimulant and opioid users.
- • Mood and anxiety disorders increased the risk of transitioning to AUD and CUD.
- • The rapidity of transition to SUD emphasizes the narrow opportunity to intervene.
Conclusion: The relative speed associated with the transition from use to SUD emphasizes the narrow window of time available to intervene, underscoring the urgency of early identification of mental health conditions and the timely provision of appropriate evidence-based interventions, which could potentially prevent the development of secondary SUDs.
The interdependence of cigarette, alcohol, and marijuana use in the context of school-based social networks
Cheng Wang1 *, John R. Hipp2,3, Carter T. Butts3,4, Cynthia M. Lakon5 1 Department of Sociology, University of Notre Dame, Notre Dame, IN, United States of America, 2 Department of Criminology, Law and Society, University of California, Irvine, Irvine, CA, United States of America, 3 Department of Sociology, University of California, Irvine, Irvine, CA, United States of America, 4 Department of Statistics, University of California, Irvine, Irvine, CA, United States of America, 5 Program in Public Health, University of California, Irvine, Irvine, CA, United States of America
Abstract: The concurrent or sequential usage of multiple substances during adolescence is a serious public health problem. Given the importance of understanding interdependence in substance use during adolescence, the purpose of this study is to examine the co-evolution of cigarette smoking, alcohol, and marijuana use within the ever-changing landscape of adolescent friendship networks, which are a primary socialization context for adolescent substance use. Utilizing Stochastic Actor-Based models, we examine how multiple simultaneous social processes co-evolve with adolescent smoking, drinking, and marijuana use within adolescent friendship networks using two school samples from early waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health). We also estimate two separate models examining the effects from using one substance to the initiation and cessation of other substances for each sample.
Based on the initial model results, we simulate the model forward in time by turning off one key effect in the estimated model at a time, and observe how the distribution of use of each substance changes. We find evidence of a unilateral causal relationship from marijuana use to subsequent smoking and drinking behaviors, resulting in the initiation of drinking behavior.
Marijuana use is also associated with smoking initiation in a school with a low substance use level, and smoking cessation in a school with a high substance use level. In addition, in a simulation model excluding the effect from marijuana use to smoking and drinking behavior, the number of smokers and drinkers decreases precipitously. Overall, our findings indicate some evidence of sequential drug use, as marijuana use increased subsequent smoking and drinking behavior and indicate that an adolescent’s level of marijuana use affects the initiation and continuation of smoking and drinking
More People Are Inhaling Heroin, And It's Destroying Brain Tissue
Ed Cara Jul 10, 2018, 4:00pm
People living with opioid addiction are increasingly using the inhalation method to get high, warns a new review published Monday in JAMA Neurology. The technique known as “chasing the dragon”, which involves heating up heroin and inhaling its fumes through a pipe, may be safer in some ways than injection, but it comes with its own set of devastating side effects, including irreversible brain damage and dementia.
The doctors behind the study, led by neurologist Ciro Ramos-Estebanez of the University Hospitals Cleveland Medical Center in Ohio, were inspired to study the topic after coming across a strange case in 2015.
A young woman suffering from opioid intoxication had fallen into a coma. The coma was caused by a build up of spinal fluid in her brain, a condition known as hydrocephalus. The woman’s spinal fluid had become trapped by chronic inflammation in the brain caused by inhaling heroin.
She ultimately recovered from her coma, though with lasting cognitive impairment, after doctors performed emergency surgery that drained the lodged spinal fluid.
It was the first case of hydrocephalus linked to inhaled heroin ever reported, and it made Ramos-Estebanez and his team eager to understand the phenomenon better
Looking at more than 30 studies and case reports, which included the cases of two other patients at their hospital, the team settled on some basic observations.
For one, while there’s sparse information on how often addicts are inhaling heroin, the little data that does exist suggests it’s the fastest growing method of use, the team found.
In countries such as Sri Lanka, Norway and India, over two-thirds of heroin users admit inhaling it regularly. In the US, injection is still the most common method, but inhalation is increasing, especially in cities and areas east of the Mississippi.
It’s also becoming more popular among teens. In 2014, the team found, 21 per cent of all inpatient hospital visits due to heroin abuse among 12- to 19-year-olds involved inhalation.
The extent of damage caused by inhaling heroin also runs along a spectrum. At its mildest, it can cause memory loss and mild but long-lasting cognitive impairment; at its worst, it can kill off and create sponge-like holes in the brain’s white matter, the bundles of connective fibre that allow brain cells to talk to one another. That can lead to seizures, problems speaking, progressively worse dementia, coma and death.
Ramos-Estebanez and his team also developed a theory as how and why this damage happens. The high temperatures used to vaporise heroin, they speculate, metabolise it into a chemical that can cross the blood-brain barrier with greater ease. And because how fast it gets to the brain, these chemicals aren’t metabolised by the body into a relatively less toxic substance. The end result is a potent high that is more directly dangerous to the brain.
“Most people who take heroin intravenously don’t develop this condition,” Ramos-Estebanez said. “You’re actually washing out the dose a bit before it gets to the brain.”
Ultimately, Ramos-Estebanez wants doctors and the public to treat inhaled heroin as an emerging public health problem. Being able to recognise its signs in opioid users earlier might just be life-saving, too: Some small studies have identified a few drugs that seem capable of preventing further brain damage if administered quickly enough.
Outside of these sites, Ramos-Estebanez wants to dispel the notion that inhaling heroin is necessarily safer than other routes, such as injection. Many people, for instance, may inhale to avoid the risk of catching bloodborne diseases through contaminated needles.
“‘Chasing the dragon’ is not as safe as portrayed. And this isn’t something some doctor is saying to scare people away, it’s reality,” Ramos-Estebanez said. “It’s a heavy cost for patients, their families and society itself.”
In addition to creating accurate criteria that doctors can use to diagnose people who have brain damage caused by inhaled heroin, Ramos-Estebanez and his team are also currently trying to establish a registry so cases can be better tracked and studied.
Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis
Results: Overall, 32.2% (95% CI=29.7–34.9) of patients with a substance-induced psychosis converted to either bipolar or schizophrenia-spectrum disorders. The highest conversion rate was found for cannabis-induced psychosis, with 47.4% (95% CI=42.7–52.3) converting to either schizophrenia or bipolar disorder. Young age was associated with a higher risk of converting to schizophrenia. Self-harm after a substance-induced psychosis was significantly linked to a higher risk of converting to both schizophrenia and bipolar disorder. Half the cases of conversion to schizophrenia occurred within 3.1 years after a substance-induced psychosis, and half the cases of conversion to bipolar disorder occurred within 4.4 years.
Conclusions: Substance-induced psychosis is strongly associated with the development of severe mental illness, and a long follow-up period is needed to identify the majority of cases.
Getting enough sleep – Eating right – Little Bit of exercise, and cut down on sugar and ‘screen time’ will all help Executive Function and reduce the potential for SUD?
Adolescent Executive Dysfunction in Daily Life: Relationships to Risks, Brain Structure and Substance Use.
During adolescence, problems reflecting cognitive, behavioural and affective dysregulation, such as inattention and emotional dyscontrol, have been observed to be associated with substance use disorder (SUD) risks and outcomes. Prior studies have typically been with small samples, and have typically not included comprehensive measurement of executive dysfunction domains. The relationships of executive dysfunction in daily life with performance based testing of cognitive skills and structural brain characteristics, thought to be the basis for executive functioning, have not been definitively determined. The aims of this study were to determine the relationships between executive dysfunction in daily life, measured by the Behaviour Rating Inventory of Executive Function (BRIEF), cognitive skills and structural brain characteristics, and SUD risks, including a global SUD risk indicator, sleep quality, and risky alcohol and cannabis use. In addition to bivariate relationships, multivariate models were tested. The subjects (n = 817; ages 12 through 21) were participants in the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study.
The results indicated that executive dysfunction was significantly related to SUD risks, poor sleep quality, risky alcohol use and cannabis use, and was not significantly related to cognitive skills or structural brain characteristics. In multivariate models, the relationship between poor sleep quality and risky substance use was mediated by executive dysfunction. While these cross-sectional relationships need to be further examined in longitudinal analyses, the results suggest that poor sleep quality and executive dysfunction may be viable preventive intervention targets to reduce adolescent substance use.
A psychological perspective on addiction – Professor Robert West
Addiction is a chronic condition, learned through experience, involving repeated powerful motivation to engage in a behaviour to an extent that causes, or risks, significant unintended harm. Addiction cannot be adequately understood in terms of any one discipline, but each of the disciplines of the behavioural and social sciences, from neuroscience to anthropology, can provide valuable insights.
For complete article and to download the PowerPoint Presentation click on the link below.
Research on Illicit Drugs
- Basic science - Bedrock of progress
- Cannabis Abusers Show Hypofrontality and Blunted Brain Responses to a Stimulant Challenge in Females but not in Males
- Chronic Methamphetamine Effects on Brain Structure and Function in Rats
- Don't Worry, Be Happy - Endocannabinoids and Cannabis at the Intersection of Stress and Reward
- Is biological ageing accelerated in drug addiction, Volkow, Klein, 2017
- Neurobiology of addiction - a neurocircuitry analysis
and CANNABIS AS MEDICINE?
Check out the material on Cannabis as Medicine? at Dalgarno Institute - Cannabis as Medicine?
Check out the materian in Cannabus Conundrum at Dalgarno Institute - Cannabis Conundrum
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.
The RiverMend Health Website - RiverMend Health is a premier provider of evidence-based, scientifically driven addiction medicine delivering world-class treatment through our nationwide network of leading addiction recovery experts and treatment centers...
Centre for Disease Control – FASDs: Information for Women
Five Things You Should Know about Drinking Alcohol during Pregnancy
- Drinking alcohol during pregnancy can cause miscarriage, stillbirth, and a range of lifelong physical, behavioral, and intellectual disabilities. These disabilities are known as fetal alcohol spectrum disorders, or FASDs. People with FASDs can have learning disabilities, hyperactivity, difficulty with attention, speech and language delays, low IQ, and poor reasoning and judgment skills. They can also have problems with their organs, including the heart and kidneys.
- There is no known safe amount of alcohol use during pregnancy or while trying to get pregnant. All drinks with alcohol can affect a baby’s growth and development and cause FASDs. A 5-ounce glass of red or white wine has the same amount of alcohol as a 12-ounce can of beer or a 1.5-ounce shot of straight liquor.
- There is no safe time to drink during pregnancy. Alcohol can cause problems for a developing baby throughout pregnancy, including before a woman knows she is pregnant. Most women will not know they are pregnant for up to 4 to 6 weeks.
- Too many women continue to drink during pregnancy. About 1 in 9 pregnant women in the United States reports alcohol use in the past 30 days. And about 1 in 26 pregnant women in the United States reports binge drinking in the past 30 days (having four or more drinks at one time).
- Fetal Alcohol Spectrum Disorders (FASDs) are completely preventable. FASDs are completely preventable if a woman does not drink alcohol during pregnancy. Why take the risk?
Esketamine for Treatment-Resistant Depression — First FDA-Approved Antidepressant in a New Class
Treating major depressive disorder remains an important challenge worldwide. The disorder impairs productivity, social functioning, and overall health, reducing life expectancy and burdening health care systems.1 Although many treatments exist, at least a third of patients do not have a response after two or more trials of antidepressant drugs and are considered to have treatment-resistant depression.2 Such patients have an increased risk of suicide relative to both the general population and patients with nonresistant major depressive disorder; at least a third of them attempt suicide.3
The FDA recently approved the S-enantiomer of ketamine, esketamine, a rapidly acting drug shown to be effective in patients with treatment-resistant depression.
Balancing these potential risks with the benefits of an effective drug for a serious disease for which there is substantial unmet need, the FDA approved esketamine with a Risk Evaluation and Mitigation Strategy (REMS). The intent of the REMS is to mitigate the risk of serious adverse outcomes resulting from sedation, dissociation, and abuse and misuse, while providing access to this effective treatment for treatment-resistant depression. Esketamine will be dispensed and administered to patients only in a medically supervised health care setting where they can be monitored for adverse reactions for at least 2 hours; pharmacies that dispense esketamine must ensure that the drug is dispensed only to clinics and hospitals that are certified in the REMS.
Learn About E-Cigarettes!
Electronic cigarettes, or e-cigarettes, were invented in 2003 by Chinese inventor and pharmacist Hon Lik. Although many companies and advocates continue to bill them as a safer, smokeless alternative to traditional cigarettes, a U.S. Surgeon General report alarmingly found that 16% of high school students regularly use e-cigarettes. What’s worse, many young people who begin using nicotine through e-cigarettes will start to use traditional cigarettes later, according to the National Institute on Drug Abuse.
Smokers need help to quit, and those who can’t quit deserve a safer alternative. However, there’s a growing body of research indicating that e-cigarettes do more harm than good, and the companies selling them shamelessly advertise these products to youth in order to attract lifelong, valuable customers in ways that tobacco companies are prohibited from doing:
- E-cigarette companies use candy and fruit flavors that are known to attract youth.
- They spend millions of dollars on aggressive marketing tactics.
- They spend millions more lobbying to stop life-saving regulations.
- They produce their own research, claiming that e-cigarettes pose only a minimal risk to users despite having no long-term evidence to make that claim.
- And, their products only minimally increase the number of smokers who are able to quit.
We support the Food and Drug Administration’s crackdown on e-cigarettes because with millions of teens using e-cigarettes every year, this is the beginning of an epidemic of nicotine addiction, and we invite you to learn more about these new nicotine delivery systems from the resources below.
Launched by the U.S. Surgeon General's office, Know the Risks: E-Cigarettes & Young People has quick and ready access to information about what e-cigarettes are, the trends in use, why they're bad for youth, and much more.
The National Institute on Drug Abuse provides this fact sheet about e-cigarettes, which includes their effects on teens, how teens are using them, the link between e-cigarette use and traditional cigarette use, and information about nicotine addiction.
The US Opioid Crisis is more than it appears!
The Institute for Behavior and Health is pleased to share with you an interview of IBH President Robert L. DuPont, MD featured in Opioid Watch of The Opioid Research Institute:
Cost Legal Cannabis ILLINOIS - REPORT
Conclusion: USA – Illinois: Even under this conservative scenario, and omitting important cost centers such as long-term health costs, marijuana legalization will cost Illinois approximately $670.5 million in 2020, significantly more than the $566 million in revenues that pro-legalization activists project.
The Moral Hazard of Lifesaving Innovations: Naloxone Access, Opioid Abuse, and Crime
March 6, 2018 - Abstract
Naloxone access may unintentionally increase opioid abuse through two channels: (1) saving the lives of active drug users, who survive to continue abusing opioids, and (2) reducing the risk of death per use, thereby making riskier opioid use more appealing. By increasing the number of opioid abusers who need to fund their drug purchases, Naloxone access laws may also increase theft. We exploit the staggered timing of Naloxone access laws to estimate the total effects of these laws. We find that broadening Naloxone access led to more opioid-related emergency room visits and more opioid-related theft, with no reduction in opioid-related mortality.
Nutrition in Addiction Recovery
This document has been prepared to educate people about how drugs and alcohol can disrupt the normal functioning of the body and how better nutrition can help diminish some of these biochemical and digestive problems. This document only focuses on one specific component of a comprehensive recovery treatment program—better nutrition. It is not intended to be used as a substitute for a doctor’s advice or as a recovery treatment program.
Beyond Supply: How We Must Tackle the Opioid Epidemic
Email the author MD A. Benjamin Srivastava, Mark S. Gold, MD
Department of Psychiatry, Washington University School of Medicine, St Louis, MO
The opioid epidemic is the most important and most serious public health crisis today. The effects are reported in overdose deaths but are also starkly evident in declines in sense of well-being and general health coupled with increasing all-cause mortality, particularly among the middle-aged white population.1 As exceptionally well described by Rummans et al in this issue of Mayo Clinic Proceedings, the cause of the epidemic is multifactorial, including an overinterpretation of a now infamous New England Journal of Medicine letter describing addiction as a rare occurrence in hospitalized patients treated with opioids, initiatives from the Joint Commission directed toward patient satisfaction and the labeling of pain as the “5th vital sign,” the advent of extended-release oxycodone (OxyContin), an aggressive marketing campaign from Purdue Pharma L.P., and the influx of heroin and fentanyl derivatives.
To date, most initiatives directed toward fighting the opioid initiatives, and the focus of the discussion from Rummans et al, have targeted the “supply side” of the equation. These measures include restricting prescriptions, physician drug monitoring programs, and other regulatory actions. Indeed, although opioid prescriptions have decreased from peak levels, the prevalence of opioid misuse and use disorder remains extremely prevalent (nearly 5%). Further, fatal drug overdoses, to which opioids contribute to a considerable degree, continue to increase, with 63,000 in 2016 alone.6 Thus, although prescription supply and access are necessary and important, we need to address the problem as a whole. To this point, for example, the ease of importation and synthesis of very cheap and powerful alternatives (eg, fentanyl and heroin) and the lucrative US marketplace have contributed to the replacement pharmacy sales and diversion with widespread street-level distribution of these illicit opioids; opioid-addicted people readily switch to these illicit opioids.
A complementary and necessary approach is to target the “demand” side of opioid use, namely, implementation of preventive measures, educating physicians, requiring physician continuing education for opioid prescribing licensure, and addressing why patients use opioids in the first place. Indeed, prevention of initiation of use is the only 100% safeguard against addiction; however, millions of patients remain addicted, and they need comprehensive, rather than perfunctory, treatment. Rummans and colleagues are absolutely correct in their delineation of the unwitting consequences of a focus on pain, given that a perceived undertreatment of pain fueled the opioid epidemic in the first place. They are correct to point out how effective pain evaluation and treatment are much more than prescribing and should routinely include psychotherapy, interventional procedures, and nonopioid therapies. In addition, we have described the crossroads between pain and addiction as well as successful strategies to manage patients with both chronic pain syndromes and addiction.
The Key Role of Prevention In Addressing the Current Landscape of Substance Abuse in America: A Perspective
Presented 2018 Annual PREVENTION DAY February 2018
Elinore F. McCance-Katz, MD, PhD – Assistant Secretary for Mental Health and Substance Use
Substance Abuse and Mental Health Services Administration (U.S. Department of Health and Human Services)
Reducing Addiction Must Begin with Youth Prevention
Iceland knows how to stop teen substance abuse but the rest of the world isn’t listening!
Today, Iceland tops the European table for the cleanest-living teens. The percentage of 15- and 16-year-olds who had been drunk in the previous month plummeted from 42 per cent in 1998 to 5 per cent in 2016. The percentage who have ever used cannabis is down from 17 per cent to 7 per cent. Those smoking cigarettes every day fell from 23 per cent to just 3 per cent.
The way the country has achieved this turnaround has been both radical and evidence-based, but it has relied a lot on what might be termed enforced common sense. “This is the most remarkably intense and profound study of stress in the lives of teenagers that I have ever seen,” says Milkman. “I’m just so impressed by how well it is working.”
If it was adopted in other countries, Milkman argues, the Icelandic model could benefit the general psychological and physical wellbeing of millions of kids, not to mention the coffers of healthcare agencies and broader society. It’s a big if.