Schism on "-isms"

There's been a modern divergence in thinking on how to treat various addictions to substances. The old 28-day treatment and AA ever-after absolute abstinence plan is completely without individuality or spectrum thinking. I was reading a piece in the NYT by an alcoholic on the holidays and how he avoids parties so as to avoid drinking, and saw his two references to the modern skeptics of AA/absolutism: Drink/Link and Moderation Management. Although it may be possible that some people's brains are too tuned to alcohol to enjoy it moderately (which he self-identifies with), it has to be true that there is a spectrum to the "disease" of alcoholism just as with any other. Those on the "less sick" side of it can almost certainly receive a different treatment method.

From my own background and the people I've known who have been on other substances than alcohol or pot, there is probably a very different truth about addiction to opioids and such. I would apply zero tolerance there, in fact, as these drugs don't have the same pharmacology and cannot be "enjoyed moderately" as pot and alcohol might.

(BTW: Jim Atkinson wrote two other interesting pieces on drinking here and here)

On a slightly tangential note (but still drug-related), last night Amber and I watched an interesting program called "Marijuana Nation" on NGC and I was fascinated and educated. It went through a number of issues on medical marijuana, the federal vs. state legal clashes, the way growers use state parks and trash natural resources, and inside a professional growing operation that has to be one of the most scientifically-advanced in the country. It almost makes one want to have another dance with Mary Jane, and if not with her, then an interesting evening with a toadstool.

Cannibas less harmful than tobacco or alcohol

Duh.

I've written more about it before, and it's a little complicated.

New WaPo article on Cindy McCain's drug addiction

I am inclined to agree with Barack that:

“Let me be as clear as possible,” said Obama, “I think people’s families are off-limits and people's children are especially off-limits. This shouldn't be part of our politics."

On the other hand, a case can be made that when a politician's policies collide with their actions and personal beliefs, there is a hypocrisy to talk about. Kind of like Palin's denial to women who are victims of rape or incest the right to choose while claiming, straight-faced, that her daughter had "made the choice" to keep her baby: a choice she wants to deny to other women. Kind of like McCain's accusations that Obama was a "celebrity" with his own dozens of cameos, the TV memoir "Faith of my Fathers" and TV appearances. And so a politician, by their duplicity and stupidity, can drag their family into the middle of a serious discussion on issues.

In this case, John McCain supports the drug war (Obama doesn't, but has weakened his earlier stance on full legalization), while he got his wife out of trouble for stealing drugs from her medical charity during her hydrocodone-addiction phase. We may never end the drug war, although some concrete first steps are being taken in the right direction. However, we can't continue to allow politicians to "look tough" by putting potheads and crack addicts behind bars (rather than getting them help) while in their own personal lives, using their power to exonerate a family member from legal prosecution.

A Tangled Story of Addiction
Consequences of Cindy McCain's Drug Abuse Were More Complex Than She Has Portrayed

By Kimberly Kindy
Washington Post Staff Writer
Friday, September 12, 2008; A01

When Cindy McCain is asked what issues she would champion as first lady, she often cites one of the most difficult periods of her life: her battle with -- and ultimate victory over -- prescription painkillers. Her struggle, she has said repeatedly, taught her valuable lessons about drug abuse that she would pass on to the nation.

"I think it made me a better person as well as a better parent, so I think it would be very important to talk about it and be very upfront about it," McCain said in an interview with "Access Hollywood." In an appearance on the "Tonight Show With Jay Leno," she said she tries "to talk about it as much as possible because I don't want anyone to wind up in the shoes that I did at the time."

In describing her struggle with drugs, McCain has said that she became addicted to Vicodin and Percocet in early 1989 after rupturing two disks and having back surgery. She has said she hid her addiction from her husband, Sen. John McCain, and stopped taking the painkillers in 1992 after her parents confronted her. She has not discussed what kind of treatment she received for her addiction, but she has made clear that she believes she has put her problems behind her.

While McCain's accounts have captured the pain of her addiction, her journey through this personal crisis is a more complicated story than she has described, and it had more consequences for her and those around her than she has acknowledged.

Her misuse of painkillers prompted an investigation by the Drug Enforcement Administration and local prosecutors that put her in legal jeopardy. A doctor with McCain's medical charity who supplied her with prescriptions for the drugs lost his license and never practiced again. The charity, the American Voluntary Medical Team, eventually had to be closed in the wake of the controversy. Her husband was forced to admit publicly that he was absent much of the time she was having problems and was not aware of them.

"So many lives were damaged by this," said Jeanette Johnson, whose husband, John Max Johnson, surrendered his medical license. "A lot of good people. Doctors who volunteered their time. My husband. I cannot begin to tell you how painful it was. We moved far away to start over."

McCain's addiction also embroiled her with one of her charity's former employees, Tom Gosinski, who reported her drug use to the DEA and provided prosecutors with a contemporaneous journal that detailed the effects of her drug problems. He was later accused by a lawyer for McCain of trying to extort money from the McCain family.

"It's not just about her addiction, it's what she did to cover up her addiction and the lives of other people that she ruined, or put at jeopardy at least," Gosinski said in an interview this week.

Cindy and John McCain declined repeated requests to be interviewed for this article. The McCain campaign also declined to comment.

Based on the limited details they have provided in earlier interviews, it is impossible to tell the full story of a difficult period in their lives. The following account of Cindy McCain's prescription drug abuse and her and her husband's efforts to deal with it is based on official records, including a report by the county attorney's office in Phoenix, and on interviews with local and federal officials involved in the probe.

Politics and Philanthropy

In 1988, during her husband's first Senate term, Cindy McCain founded the American Voluntary Medical Team, a nonprofit that sent volunteer doctors and nurses to provide free medical care in Third World countries and U.S. disaster zones. Cindy McCain served as president, operating out of her family's business, a giant Anheuser-Busch beer distributorship in Phoenix owned by her father.

The McCains had married in 1980. They moved to Washington after he was first elected to the House of Representatives in 1982. But she later returned to Phoenix, her home town, believing it was a better place to raise a family. Sen. McCain commuted home on weekends.

Even far from Washington, politics took a toll on Cindy McCain. In 1989, she was pulled into a Senate investigation that focused on her husband and four other senators who had intervened with regulators on behalf of savings-and-loan owner Charles Keating.

When questions arose about a vacation the McCains took to Keating's home in the Bahamas, Cindy McCain, as family bookkeeper, was asked to document that they had reimbursed the Keatings, but she could not. She has repeatedly cited the stress of the Keating Five scandal and pain from two back surgeries that same year as reasons for her dependence on painkillers.

Her charity, AVMT, kept a ready supply of antibiotics and over-the-counter pain medications needed to fulfill its medical mission. It also secured prescriptions for the narcotic painkillers Vicodin, Percocet and Tylenol 3 in quantities of 100 to 400 pills, the county report shows.

McCain started taking narcotics for herself, the report shows. To get them, she asked the charity's medical director, John Max Johnson, to make out prescriptions for the charity in the names of three AVMT employees.

The employees did not know their names were being used. And under DEA regulations, Johnson was supposed to use a form to notify federal officials that he was ordering the narcotics for the charity. It is illegal for an organization to use personal prescriptions to fill its drug needs.

"The DEA told me it was okay to do it that way," Johnson told The Washington Post recently, in his first media interview about the case. "Otherwise, I never would have done it."

The county report showed that Johnson told officials he knew it was wrong, but he wrote prescriptions at McCain's request at least twice.

After Johnson wrote the prescriptions, McCain, and sometimes her secretary, picked them up from his home. Once they were filled, Johnson was supposed to maintain custody of the narcotics, but he said he let McCain control them and carry the medications in her luggage on charity trips.

No one tracked the narcotics in between the charity's missions, the county report shows.

When the county investigator asked Johnson where the charity stored its narcotics, he said they were in a safe. When asked where the safe was located, Johnson said he had never seen it.

Officials with other medical charities contacted by The Post said it is unusual to distribute narcotics overseas, particularly in Third World countries where medical teams treat disease and infection rather than performing painful surgeries.

Some of the doctors and nurses who went on McCain's missions said they never saw narcotics on AVMT trips and would have discouraged carrying such medications. "You don't bring narcotics into a foreign country, especially with people who have machine guns around," said Michele Stillinger, a nurse during a 1991 AVMT mission to Bangladesh.

'I Noticed the Mood Swings'

Tom Gosinski, then 32, met Cindy McCain while working for America West Airlines and coordinating an AVMT flight to Kuwait. She hired him in 1991.

He grew close to the McCain family. He knew the domestic staff, as well as Cindy's father, James, and mother, Marguerite.

Thinking he might one day write a book, Gosinski kept a journal that he later turned over to investigators. His entries about AVMT suggest that McCain's behavior led employees to believe she was using drugs.

"Right away, I noticed the mood swings," Gosinski told The Post in June. "She wouldn't show up at the office, and we'd call her home. Her house staff would say she hadn't come out of her room yet. It would be 11 a.m. or noon."

As time wore on, his diary chronicled office concerns that McCain was taking pills from the charity's inventory. Gosinski developed a code for her behavior, the county report shows. On days when his boss appeared to be in a good mood, he wrote "OP," for "on Percocet." Bad days were called "NOP," for "not on Percocet."

On July 20, 1992, he wrote, "I really don't know what is going on but I certainly hope that Cindy does not get herself of [sic] AVMT in trouble."

A relative of McCain's told charity staff members that McCain's parents planned to confront her about her behavior, according to the journal. McCain has said they did so in late 1992, asking whether painkillers were causing her "erratic" conduct. Gosinski's journal indicates he heard about the confrontation the next day, Oct. 2, 1992.

McCain's relationship with Gosinski soon deteriorated. In January 1993, she ordered him to stop gossiping about her, Gosinski said. Soon after, she fired him but wrote him a glowing termination letter.

Gosinski eventually returned to America West as a travel consultant and worked part time in a bookstore.

The Investigation Begins

Three weeks after his firing, Gosinski contacted Phoenix DEA agents and gave them a copy of his journal.

The DEA questioned the charity's doctors, and McCain hired John Dowd, a powerhouse Washington lawyer, to represent AVMT. Dowd had defended John McCain in the Keating Five scandal, helping the senator win the mildest sanction of the five senators involved. Dowd declined to comment for this article.

Soon, the DEA began looking at Cindy McCain. Dowd informed Johnson, the physician, that "there's been further investigation and Cindy's got a drug problem," Johnson told county investigators.

The DEA pursued the matter for 11 months. Dowd kept tabs on the investigation from Washington, writing letters and making frequent phone calls to the agency, according to sources close to the investigation.

McCain's conduct left her facing federal charges of obtaining "a controlled substance by misrepresenting, fraud, forgery, deception or subterfuge." Experts say she could have faced a 20-year prison sentence.

Dowd negotiated a deal with the U.S. attorney's office allowing McCain, as a first-time offender, to avoid charges and enter a diversion program that required community service, drug treatment and reimbursement to the DEA for investigative costs. Johnson agreed to surrender his medical license and retire.

With final negotiations between federal prosecutors and Dowd still underway, Gosinski sued McCain for wrongful termination.

On Feb. 4, 1994, Gosinski's attorney, Stanley Lubin, wrote to McCain, saying his client had omitted certain details in his lawsuit "due to their sensitive nature." He said that for $250,000, Gosinski would drop the action. Lubin said in an interview that he met with Dowd, who said the lawsuit was without merit. "He told me if I thought the senator was going to cave into this extortion, I was going to learn a very serious lesson," Lubin recalled.

On April 28, 1994, Dowd wrote to Maricopa County Attorney Richard Romley, a Republican, asking that Gosinski be investigated for attempted extortion.

Romley agreed. Dowd and Cindy McCain lined up witnesses and prepared a brief to support the contention that Gosinski's job performance was unacceptable and that he was of questionable character, assertions he denied.

In May of that year, county investigator Terry Blake interviewed McCain at her Phoenix home. He asked questions about Gosinski and then grilled McCain about prescription painkillers. He later wrote:

"Mrs. McCain was asked if AMVT procured narcotic drugs as a part of their normal operation. She said they did.

"I asked if she ever obtained narcotic drugs by using her employee's names. She said she did.

"Mrs. McCain was asked if prescriptions were written in Mr. Gosinski's name without his knowledge. She said yes."

McCain told Blake she once had a dependence on painkillers, according to the report, which included the interview summary and copies of her illegal prescriptions. The probe of possible extortion by Gosinski was closed without charges.

After the case was closed, prosecutors told McCain's lawyer that they would make the report public. Before it was released, Sen. McCain dispatched Jay Smith, then his top strategist, to Phoenix to line up interviews between Cindy McCain and journalists from four selected media outlets who were unaware of the report. Smith did not include two news organizations that had learned about the report, the Arizona Republic and New Times, an alternative weekly in Phoenix.

McCain told the reporters that she was stepping forward willingly. "If what I say can help just one person to face the problem, it's worthwhile," she said.

Two reporters wrote that McCain said she had completed a drug treatment program at the Meadows, a facility in Wickenberg, Ariz., as part of the agreement with federal prosecutors. But days later, federal officials said that no agreement had been reached and that she had not yet been accepted into a diversion program, which would include approved treatment. McCain issued a statement saying the reporters erred, but she did not disclose details of her treatment.

The only public reference to treatment is her mention in the county investigator's report of a one-week stay at the Meadows.

Once the county report was released, along with Gosinski's journal, a few reporters challenged McCain's account. Only New Times published excerpts from Gosinski's diary. Within a few weeks, the story died in Arizona, without receiving national exposure. Gosinski ultimately ran out of money and let his lawsuit against McCain die.

Gosinski, who has moved to Nebraska, was initially reluctant to tell his story when contacted by The Post in May. He is still viewed with enmity by some in the drug investigation, including the Johnsons, who hold him responsible for the doctor's troubles.

He eventually gave several lengthy interviews and provided The Post with a copy of his journal. He subsequently cut off contact and asked that his name not be printed, saying he became frightened by the prospect of facing the McCain campaign on his own.

On Wednesday, he said he had changed his mind. He appeared at a news briefing in Arlington set up by a Democratic Party consultant. Gosinski, a registered Republican, said that he sought help orchestrating a single media event because so many reporters wanted his story, but that he has had no contact with the Obama campaign or the Democratic National Committee.

He also signed an agreement with the Center for Responsibility and Ethics in Washington, a D.C.-based watchdog group, which will provide legal representation for him in the event of a lawsuit.

Controversy Fades

McCain's drug use became national news during her husband's first presidential campaign in 2000. Newsweek published a first-person account of her struggle, but it included some errors.

"It began with Vicodan [sic]. In 1989, I had ruptured a couple of disks carrying my 1-year-old, Bridget, in a pack on my back," she wrote.

But Bridget was not born until 1991. In other accounts, McCain said she hurt her back while picking up her son Jimmy, who was a toddler at the time of her injuries.

As the McCains traveled in the Straight Talk Express bus in 2000, interest in Cindy McCain's story faded when it became clear that she and her husband weren't headed for the White House.

This year, as the McCains campaigned again, Cindy McCain granted interviews about her past problems to "Access Hollywood" and Jay Leno. She called her addiction a life-changing crisis.

"Your life experiences make you," she told "Access Hollywood," "and hopefully you learn from them."

Research editor Alice Crites and staff researcher Madonna Lebling contributed to this report.

Does this make McCain unfit for the presidency? No. But I think it shows the clear double standard on his part as to how he treats other people in Cindy's situation by sending them to prison, rather than helping them get treatment and recover.

Question to Barack from Balko

In the same vein as my mention of HR 5843, Radley Balko writes a column asking Barack some questions, and one is directly concerned with his stance on decriminalization:

In your autobiography, you admit to using marijuana and cocaine in high school and college. Yet you largely support the federal drug war — a change from several years ago when you said you'd be open to decriminalizing marijuana. Would Barack Obama be where he is today if he had been arrested in college for using drugs? Doesn't the fact that you and our current president (who has all but admitted to prior drug use) have risen to such high stature suggest that the worst thing about illicit drugs is not the drugs themselves, but what the government will do to you if you're caught?

Bingo. The number of people in our country who have at least tried pot is staggeringly high, with at least 15 million people in the US having smoked marijuana within the last month. This while the overwhelming majority of those people go on to lead completely normal lives drug-free later one (I am one). Why ruin their chances to have good jobs and educational opportunities [Federal law prohibits people who've been caught with pot from receiving financial aid]?

It's far past time to decriminalize, for a plethora of reasons.

Support HR 5843 to federally decriminalize pot

Barney Frank has introduced, with 7 co-sponsors, a bill in the House to reform marijuana criminalization. Basically, the bill would decriminalize possession of under 100 grams, or a not-for-profit transfer of up to one ounce of medical marijuana. Note that this is only a federal law, but it is a major step in the right direction.

This is a real chance to save billions of dollars of wasted government money prosecuting teenagers and college kids, as well as relieving the state of thousands of people imprisoned on probation violations or similar charges. Every day, child molesters and murderers are paroled due to lack of space, in order to make room for Jane and John Doe potheads...

Although Obama supports medical marijuana, he appears to have backed off earlier promises to work to decriminalize marijuana, probably because of the flak he took from admitting to have experimented in high school during the primary.

McCain still wants those damned kids off his lawn smoking that reefer.

HR 5843

The failure of the "War on Drugs"

On a drug-related note, check out this piece in the LA Times today that summarizes the failure of the "war on drugs"...

Spirituality and drugs

Back when I was running Gator Freethought (AAFSA at the time), I was often pressed for creative material to use at our non-guest-speaker meetings. At one meeting, I decided to talk about the role of drugs in so-called "spiritual" or transcendent experiences, and especially drugs like psilocybin, after reading about it at world-science.net that previous week. The meeting went fairly well, I guess, although I admittedly wasn't as prepared as I should have been.

The long story short is that some drugs (especially psilocybin) seem to induce a state of mind akin to what Buddhist monks enter when they go into transcendental meditation, in that one loses all sense of self and an indelible sense of oneness with the cosmos emerges. That's also the report from a few friends of mine who have experimented with mushrooms.

Anyway, I was reminded of that as I read that in studies on those exposed to psilocybin, the effects on their mood and happiness have lasted a very long time -- over a year. Since my pipe dreams still include the FBI/CIA thing, I will hold off until that ship sails. After that, I think I'd like to see what transcendent experiences I can have with psilocybin.

On legal v. illegal drugs

The NYT has a fascinating news article today in which Florida state officials tallied the number of deaths caused by different drugs and found...unsurprisingly, ZERO caused by marijuana, almost 500 caused by alcohol, but a whopping 2300 caused by legal opioids:

The report’s findings track with similar studies by the federal Drug Enforcement Administration, which has found that roughly seven million Americans are abusing prescription drugs. If accurate, that would be an increase of 80 percent in six years and more than the total abusing cocaine, heroin, hallucinogens, Ecstasy and inhalants.

The Florida report analyzed 168,900 deaths statewide. Cocaine, heroin and all methamphetamines caused 989 deaths, it found, while legal opioids — strong painkillers in brand-name drugs like Vicodin and OxyContin — caused 2,328.

Drugs with benzodiazepine, mainly depressants like Valium and Xanax, led to 743 deaths. Alcohol was the most commonly occurring drug, appearing in the bodies of 4,179 of the dead and judged the cause of death of 466 — fewer than cocaine (843) but more than methamphetamine (25) and marijuana (0).

The study also found that while the number of people who died with heroin in their bodies increased 14 percent in 2007, to 110, deaths related to the opioid oxycodone increased 36 percent, to 1,253.

In November, I relayed my personal experiences with the epidemic of "hillbilly heroin" as I grew up and went through high school, and the fact that I know a few people whose experiences with oxycodone would have to match up against any horse or crack addict in terms of desperation and degradation. This study gives yet another reason to decriminalize pot: if a huge state like Florida finds ZERO deaths caused by marijuana among 170,000 deaths, the arguments that smoking dope can lead to debilitated mental faculties which, in turn, can cause death are undermined. I strongly disagree with complete libertarians with respect to drug policy who think that controlling substances is unnecessary/illegal on the part of the government, especially in light of drugs like Oxycontin(TM). That said, the legalization of marijuana is necessary, even if it may cause a slowdown of brain processing speed. I don't even smoke it (honest, not since high school, 1999), but it is definitely far past the time to de-criminalize it for a plethora of reasons.

Not the least of which being that at least 15 million people in the US have used it in the past month...and those stats are probably under-reported because of the well-known sampling bias when it comes to admitting to illegal behavior.

Don't forget, soon enough, I'll bet the government will be prosecuting people for possession on the basis of their sewage.

I would invite those of you who disagree to present a solid argument as to why marijuana should be illegal while alcohol and tobacco should remain completely legal. In addition, even if you could do that without incoherence (contradicting lines of reasoning about alcohol and tobacco), I'll bet you couldn't go a step further and argue why it should remain criminally-punishable, if it remains illegal. Keep in mind how hard it is to gain productive employment and thus remain a productive citizen with a felony on your record. Go on, I double dog dare you...

Wastewater Gumshoes 2, Pharma Water

Popular Science has a great article that forms a natural sequel to an article that I wrote about over two years ago (time flies) in Analytical Chemistry about how investigators are using wastewater (sewage) in measuring the concentrations of pharmaceutical and illegal drug byproducts and metabolites to gauge the drug usage by populations. As expected, the actual rates of drug usage by populations, as confirmed objectively in labs, is much higher than self-reported surveys tell us.

On a related note, CNN has an article about the levels of pharmaceuticals in our municipal drinking water sources. Although the levels of any one drug are very low, I do have to wonder about the multiplier effect and the issue of long-term exposure to human health. You can bet money that no one has ever conducted a study that replicates the cocktail of drugs we're exposed to over long periods of time. Maybe bottled water isn't so bad, after all...

Some politics notes

Ezra asks,

for whatever reason, our politicians seem achingly incapable of simply leaving Iraq. So it's worth asking if a military deployment is really the most cost-effective way to spend billions and billions in Iraq. This site, in fact, asks the question well. "The US budget for Iraq in FY 2006 comes to $3,749/Iraqi. This is more than double their per person GDP. It's like spending $91,000 per person in the US. Why not just bribe the whole country?" But seriously: Why not just bribe the whole country? If we're determined to commit an enormous amount of resources to the Iraqi people, why not let the Ghost of Milton Friedman take over and simply design some sort of program that offers enormous economic benefits in exchange for reductions in violence?

A win for progress in the war against "the war on drugs" -- the harsh crack sentencing guidelines are coming into line with those for powdered cocaine:

African-Americans were nearly 82 percent of defendants sentenced in federal court for dealing crack, but only 27 percent of those sentenced for dealing powder cocaine, according to 2006 federal statistics. Each year, federal courts handle about 11,000 cocaine sentences, which are roughly evenly divided between crack and cocaine cases.

The issue long has been a source of contention between government prosecutors and civil rights advocates, who argue crack dealers are often targeted for longer prison terms because that drug is prevalent in urban and minority communities, while the powdered version is more commonly associated with higher-income users.

I've said it before:

I strongly disagree with complete libertarians with respect to drug policy who think that controlling substances is unnecessary/illegal on the part of the government, especially in light of drugs like Oxycontin(TM). That said, the legalization of marijuana is necessary, even if it may cause a slowdown of brain processing speed. I don't even smoke it (honest, not since 1999), but it is definitely far past the time to de-criminalize it for a plethora of reasons.

I'd go further and point out that people who are convicted of felonies for using drugs are much less able to go on to lead productive lives afterwards due to their criminal record. This all but insures that they will remain trapped in a criminal lifestyle, and converts many formerly-productive citizens into drug dealers. I think many substances ought to be controlled by the government, but de-criminalized.

Remember, government-provided health care is terrible and will lead to a decline in quality, and Dick Cheney is proof of this!

The Dems have caved again, this time on the omnibus bill.

The dope on oxycontin & "pain doctors" in the NYT

This subject has a strong personal resonance with me; my hometown was featured in a Time article on March 28, 2005, detailing the epidemic of opoid abuse in our rural mining town. [It was not well-received, although accurate.] I have lost friends to overdosing on oxycodone, and I spent a lot of time with a lot of "pillheads" growing up (as we called them then). Just this past week, there was a shooting of a cop about one mile from where I live after a string of armed robberies involving pillheads (they were caught, of course). There is a long article in the NYT on an OD who got locked up after one of his patients died while taking...

...wait for it -- 5 80 mg OXYCONTINS IN 12 HOURS!!!!

Use of this magnitude is almost beyond my comprehension. I knew hardcore IV users who would not be able to do 400 mg a day. They could've tested this guys' wastewater for metabolites and found levels high enough to suspect a "safe house" operation was there when it was really just him...

These sorts of problems have been known for years, with an article in Time in 2001. I generally don't trust "pain management specialists", but perhaps my cynicism is simply a reflection of my personal knowledge of how many people use those doctors as avenues to addiction supply. I have first-hand experience with some of these sorts of medical experts, and by and large, my impressions are heavily tilted towards negative. They knew early on how bad oxy's were, but they kept dispensing them anyway, in part because of kickbacks. Purdue Pharma has to pay a huge amount of money ($600M) for its complicity in hiding the absurdly-addictive nature of the drug. Ignore shills for "big pharma" like Shandeek Kauship and the Cato Institute who try to pretend that all is well with that.

I strongly disagree with complete libertarians with respect to drug policy who think that controlling substances is unnecessary/illegal on the part of the government, especially in light of drugs like Oxycontin(TM). That said, the legalization of marijuana is necessary, even if it may cause a slowdown of brain processing speed. I don't even smoke it (honest, not since 1999), but it is definitely far past the time to de-criminalize it for a plethora of reasons.

Last Dance with Mary Jane

I was reading about Pat Robertson's financial woes in Radar Online, and noticed another article, Stoners vs. Six-Year-Olds: A Radar Investigation. In the (hilarious) article, two stoner adults were pitted against two (hopefully sober) young children and multiple species of monkeys. The results? The stoners failed versus kids and beasts. After reading it, though, it piqued my interest into the scientific evidence for long-term brain effects associated with marijuana use. No one disputes the acute effects, but are they reversed over time with abstinence? Apparently not, it turns out...

I still have to say that I can see no solid reasoning as to why alcohol is legal but marijuana is not. Although I do not now smoke [I promise], I support the legalization of marijuana. It is a well-known fact that long-term alcohol use can lead to as many, if not more, health defects as pot. Also, I've never heard of a "pot-related traffic accident". I used to smoke, and never had any problems operating any kind of machinery. In general, most people suspect that the government just won't legalize it because they can't tax it as effectively as they'd like. But this isn't an issue with which I'm intimately familiar, so I'll refer readers to NORML, MLO, Balanced Politics, SoYouWanna, LegalizationofMarijuana.com, CNN's special index, Wikipedia and Leighann Hedman's article.

The following is a long compilation of articles I found using simple PubMed searches. The results, summarized, are that long-term users of marijuana, even after stretches of abstinence as long as a month, show significant brain function impairment and brain structure alteration. Visit the articles for more details:

Effects of frequent marijuana use on memory-related regional cerebral blood flow

Robert I. Block, Daniel S. O'Leary, Richard D. Hichwa, Jean C. Augustinack, Laura L. Boles Ponto, M. M. Ghoneim, Stephan Arndt, Richard R. Hurtig, G. Leonard Watkins, James A. Hall et al.
Pharmacology Biochemistry and Behavior, Volume 72, Issues 1-2, May 2002, Pages 237-250
http://dx.doi.org/10.1016/S0091-3057(01)00771-7

It is uncertain whether frequent marijuana use adversely affects human brain function. Using positron emission tomography (PET), memory-related regional cerebral blood flow was compared in frequent marijuana users and nonusing control subjects after 26+ h of monitored abstention. Memory-related blood flow in marijuana users, relative to control subjects, showed decreases in prefrontal cortex, increases in memory-relevant regions of cerebellum, and altered lateralization in hippocampus. Marijuana users differed most in brain activity related to episodic memory encoding. In learning a word list to criterion over multiple trials, marijuana users, relative to control subjects, required means of 2.7 more presentations during initial learning and 3.1 more presentations during subsequent relearning. In single-trial recall, marijuana users appeared to rely more on short-term memory, recalling 23% more than control subjects from the end of a list, but 19% less from the middle. These findings indicate altered memory-related brain function in marijuana users

Effects of marijuana on neurophysiological signals of working and episodic memory.

Ilan AB, Smith ME, Gevins A. San Francisco Brain Research Institute & SAM Technology, 425 Bush Street, San Francisco, CA 94108, USA. aaron@eeg.com
Psychopharmacology (Berl). 2004 Nov;176(2):214-22. Epub 2004 May 7.
http://dx.doi.org/10.1007/s00213-004-1868-9
http://www.springerlink.com/content/b1x80ux5k8g3mh7x/

The primary psychoactive constituent of marijuana, Delta9-THC, activates cannabinoid receptors, which are especially abundant in the frontal cortex and hippocampus. Acute marijuana smoking can disrupt working memory (WM) and episodic memory (EM) functions that are known to rely on these regions. However, the effects of marijuana on the brain activity accompanying such cognitive processes remain largely unexplored. OBJECTIVES: To examine such effects on performance and neurophysiological signals of these functions, EEG recordings were obtained from ten subjects (5M, 5F) performing cognitive tasks before and after smoking marijuana (3.45% Delta9-THC) or a placebo. WM was assessed with a spatial N-back task, and EM was evaluated with a test requiring recognition of words after a 5-10 min delay between study and test. RESULTS: Marijuana increased heart rate and decreased global theta band EEG power, consistent with increased autonomic arousal. Responses in the WM task were slower and less accurate after smoking marijuana, accompanied by reduced alpha band EEG reactivity in response to increased task difficulty. In the EM task, marijuana was associated with an increased tendency to erroneously identify distracter words as having been previously studied. In both tasks, marijuana attenuated stimulus-locked event-related potentials (ERPs). CONCLUSIONS: The results suggest that marijuana disrupted both sustained and transient attention processes resulting in impaired memory task performance. In subjects most affected by marijuana a pronounced ERP difference between previously studied words and new distracter words was also reduced, suggesting disruption of neural mechanisms underlying memory for recent study episodes.

Cerebrovascular perfusion in marijuana users during a month of monitored abstinence

Ronald I. Herning, PhD, Warren E. Better, MS, Kimberly Tate, BS and Jean L. Cadet, MD
NEUROLOGY 2005;64:488-493
© 2005 American Academy of Neurology
http://www.neurology.org/cgi/content/abstract/64/3/488

Objective: To determine possible effects of prolonged marijuana use on the cerebrovascular system during a month of monitored abstinence and to assess how the intensity of current use might have influenced cerebrovascular perfusion in these marijuana users.
Method: The authors recorded blood flow velocity in the anterior and middle cerebral arteries using transcranial Doppler sonography in three groups of marijuana users who differed in the intensity of recent use (light: n = 11; moderate: n = 23; and heavy: n = 20) and in control subjects (n = 18) to assess the nature and duration of any potential abnormalities. Blood flow velocity was recorded within 3 days of admission and 28 to 30 days of monitored abstinence on an inpatient research unit in order to evaluate subacute effects of the drug and any abstinence-generated changes.
Results: Pulsatility index, a measure of cerebrovascular resistance, and systolic velocity were significantly increased in the marijuana users vs control subjects. These increases persisted in the heavy marijuana users after a month of monitored abstinence.
Conclusions: Chronic marijuana use is associated with increased cerebrovascular resistance through changes mediated, in part, in blood vessels or in the brain parenchyma. These findings might provide a partial explanation for the cognitive deficits observed in a similar group of marijuana users.

Abnormal brain activity in prefrontal brain regions in abstinent marijuana users

Dana A. Eldretha, John A. Matochikc, Jean L. Cadetd and Karen I. Bollaa,
NeuroImage Volume 23, Issue 3 , November 2004, Pages 914-920
http://dx.doi.org/10.1016/j.neuroimage.2004.07.032

We used PET 15O and a modified version of the Stroop task to determine if 25-day abstinent heavy marijuana (MJ) users have persistent deficits in executive cognitive functioning (ECF) and brain activity. Performance on a modified version of the Stroop task and brain activity was compared between 25-day abstinent, heavy marijuana users (n = 11), and a matched comparison group (n = 11). The 25-day abstinent marijuana users showed no deficits in performance on the modified version of the Stroop task when compared to the comparison group. Despite the lack of performance differences, the marijuana users showed hypoactivity in the left perigenual anterior cingulate cortex (ACC) and the left lateral prefrontal cortex (LPFC) and hyperactivity in the hippocampus bilaterally, when compared to the comparison group. These results suggest that marijuana users display persistent metabolic alterations in brain regions responsible for ECF. It may be that marijuana users recruit an alternative neural network as a compensatory mechanism during performance on a modified version of the Stroop task. These differences in brain activity may be a common denominator in the evolution of maladaptive behaviors such as substance abuse and other neuropsychiatric disorders.

Neural substrates of faulty decision-making in abstinent marijuana users

Karen I. Bollaa, b, Corresponding Author Contact Information, E-mail The Corresponding Author, Dana A. Eldretha, c, John A. Matochikd and Jean L. Cadete
NeuroImage Volume 26, Issue 2 , June 2005, Pages 480-492
http://dx.doi.org/10.1016/j.neuroimage.2005.02.012

Persistent dose-related cognitive decrements have been reported in 28-day abstinent heavy marijuana (MJ) users. However, the neural substrates of these decrements in cognitive performance are not known. This study aimed to determine if 25-day abstinent MJ users show persistent dose-related alterations in performance and brain activity using PET H215O during the Iowa Gambling Task-IGT (a decision-making task). Eleven heavy MJ users and 11 non-drug users participated. The MJ group resided in an inpatient research unit at the NIH/NIDA-IRP for 25 days prior to testing to ensure abstinence. A dose-related association was found between increased MJ use and lower IGT performance and alterations in brain activity. The MJ group showed greater activation in the left cerebellum and less activation in the right lateral orbitofrontal cortex (OFC) and the right dorsolateral prefrontal cortex (DLPFC) than the Control group. When the MJ group was divided into Moderate (8–35 joints/week) and Heavy users (53–84 joints/week), the Heavy MJ group showed less activation in the left medial OFC and greater activation in the left cerebellum than the Moderate group. However, brain activity and task performance were similar between the Moderate MJ users and the Control group, suggesting a “threshold effect”. These preliminary findings indicate that very heavy users of MJ have persistent decision-making deficits and alterations in brain activity. Specifically, the Heavy MJ users may focus on only the immediate reinforcing aspects of a situation (i.e., getting high) while ignoring the negative consequences. Thus, faulty decision-making could make an individual more prone to addictive behavior and more resistant to treatment. Finally, it is unclear if these neurologic findings will become progressively worse with continued heavy MJ use or if they will resolve with abstinence from MJ use.

Neurovascular Deficits in Cocaine Abusers

Ronald I Herning Ph.D, Deborah E King MS, Warren E Better MS and Jean L Cadet MD
Neuropsychopharmacology (1999) 21
http://www.nature.com/npp/journal/v21/n1/abs/1395324a.html

The nature of the neurological and cerebrovascular deficits in cocaine abusers and whether they persist in abstinence is unclear. Blood flow velocity of the anterior and middle cerebral arteries was measured by transcranial Doppler sonography in cocaine abusers (n = 50) and control subjects (n = 25). Blood flow velocity was measured within 3 days and again after about 28 days after being admitted to an inpatient research ward to determine whether blood flow velocity improved during monitored abstinence conditions. The mean, systolic, and diastolic velocities as well as the pulsatility index in middle and anterior cerebral arteries significantly differed between controls and cocaine abusers (p < .05). Cerebrovascular resistance is increased in cocaine abusers and the increase persists for over a month of abstinence. Further research is needed to determine whether cerebrovascular resistance can be improved by pharmacological manipulations and whether improved blood flow relates to improved treatment outcome. Reflection Impulsivity in Current and Former Substance Users.

L. Clark, T. Robbins, K. Ersche, B. Sahakian
Biological Psychiatry, Volume 60, Issue 5, Pages 515-522
http://dx.doi.org/10.1016/j.biopsych.2005.11.007

Background: Chronic drug use is associated with increased impulsivity, risky decision making, and impaired behavioral control, but the underlying mechanisms of this neurocognitive profile remain unclear. We investigated impulsive responding in the context of decision making, using a novel behavioral measure of reflection impulsivity: the tendency to gather and evaluate information before making a decision.
Methods: The Information Sampling Task was administered to current substance users dependent on amphetamines (n = 24) or opiates (n = 40), former users of amphetamines or opiates abstinent for at least 1 year (n = 24), and non–drug-using control subjects (n = 26).
Results: Current users of amphetamines and opiates sampled less information than control subjects and responded at a lower probability of making a correct response. Amphetamine- and opiate-dependent subjects did not differ. Reduced reflection was also apparent in the former substance users, who did not differ from the current users. Questionnaire ratings of impulsivity (on the Barratt Impulsivity Scale, version 11) were also inflated in three groups of substance users but were not significantly correlated with performance on the behavioral task.
Conclusions: Reduced reflection is suggested to represent a cognitive marker for substance dependence that does not recover with prolonged abstinence and is associated with multiple drugs of abuse.

Challenges of marijuana research

Ponto, L.L.B.
Brain.2006; 129: 1081-1083
http://dx.doi.org/10.1093/brain/awl092

The use of any drug ideally represents a decision based on objective, scientifically based cost–benefit analyses that factor in both the short and long-term effects of that exposure. Pharmacological, toxicological, pharmacokinetic and pharmacodynamic investigations that are deemed to be essential for the rational use of any therapeutic agent are therefore part of the usual drug approval process. With regard to marijuana, sociopolitical factors have intervened in this scientific process. Three major lay perspectives appear to dominate the societal view of marijuana—the ‘reefer madness’ camp holding the view that there are no redeeming attributes to the ‘evil weed’, the ‘innocuous’ camp who consider it to be a harmless recreational substance and the ‘medical marijuana’ camp that believes marijuana to be a panacea for a multitude of aches, pains and chronic diseases with, of course, every shade of opinion in-between. On the scientific front, three trends preface nearly every recent journal article...
[you'll want to check this one out full-text, so just pull it up on-campus, and save it to the computer in .pdf format, and email it to yourself]

Neurological assessments of marijuana users.

Cadet JL, Bolla K, Herning RI.
Methods Mol Med. 2006;123:255-68
Here

This chapter summarizes the neurological approaches used to assess the potential long-term effects of drugs on the nervous system of drug abusers. These include the use of neuropsychological assessments, transcranial Doppler (TCD) sonography, and electroencephalographic (EEG) recordings. Neuropsychological procedures are used in an effort to provide an unbiased estimate of the individual's cognitive capacity, and included tests of language skills, attention, memory, and motor skills. TCD allows for the measurements of blood flow in the anterior cerebral and middle cerebral arteries, which supply blood to the cortex. An EEG recording was included in our assessment on marijuana abusers using a sound-attenuated, electronically shielded chamber. These neurological approaches have allowed the detection of various neurological and neurovascular deficits that are associated with the abuse of marijuana.

Marijuana smoking and head and neck cancer

M Hashibe, DE Ford, and ZF Zhang
The Journal of Clinical Pharmacology, 2002; 42:103-107
http://jcp.sagepub.com/cgi/content/abstract/42/11_suppl/103S

A recent epidemiological study showed that marijuana smoking was associated with an increased risk of head and neck cancer. Among high school students and young adults, the prevalence of marijuana use was on the rise in the 1990s, with a simultaneous decline in the perception that marijuana use is harmful. It will be a major public health challenge to make people aware of the harmful effects of marijuana smoking, when some people view it as the illicit drug with the least risk. The carcinogenicity of delta9-tetrahydrocannabinol (THC) is not clear, but according to laboratory studies, it appears to have antitumor properties such as apoptosis as well as tumor-promoting properties such as limiting immune function and increasing reactive oxygen species. Marijuana tar contains similar carcinogens to tar from tobacco cigarettes, but each marijuana cigarette maybe more harmful than a tobacco cigarette since more tar is inhaled and retained when smoking marijuana. More molecular alterations have been observed in bronchial mucosa specimens of marijuana smokers compared to nonsmokers. Field cancerization may be occurring on the bronchial epithelium due to marijuana smoking exposure. Several case studies were suggestive of an association of marijuana smoking with head and neck cancers and oral lesions. However, in a cohort study with 8 years of follow-up, marijuana use was not associated with increased risks of all cancers or smoking-related cancers. Further epidemiological studies are necessary to confirm the association of marijuana smoking with head and neck cancers and to examine marijuana smoking as a risk factor for lung cancer. It will also be of interest to examine potential field cancerization of the upper aerodigestive tract by marijuana and to explore marijuana as a risk factor for oral premalignant lesions.

Cardiovascular consequences of marijuana use

S Sidney
The Journal of Clinical Pharmacology, 2002; 42:64-70
http://jcp.sagepub.com/cgi/content/abstract/42/11_suppl/64S

This review describes what is known about effects of marijuana and cannabinoids in relation to human physiological and disease outcomes. The acute physiological effects of marijuana include a substantial dose-dependent increase in heart rate, generally associated with a mild increase in blood pressure. Orthostatic hypotension may occur acutely as a result of decreased vascular resistance. Smoking marijuana decreases exercise test duration in maximal exercise tests, increases the heart rate at submaximal levels of exercise. Tolerance develops to the acute effects of marijuana smoking and delta9-tetrahydrocannibol (THC) over several days to a few weeks. The cardiovascular responses that occur in response to THC are mediated by the autonomic nervous system, with recent findings also demonstrating that the human cannabinoid receptor system plays a role in regulating the cardiovascular response. Although several mechanisms exist by which marijuana use might contribute to the development of chronic cardiovascular conditions or acutely trigger cardiovascular events, there are few data regarding marijuana/THC use and cardiovascular disease outcomes. A large cohort study showed no association of marijuana use with cardiovascular disease hospitalization or mortality. However, acute effects of marijuana use include a decrease of the time until the onset of chest pain in patients with angina pectoris; one study has shown that marijuana may trigger the onset of myocardial infarction. Patients who have coronary heart disease or are at high risk for the development of CHD should be cautioned about the potential hazards of marijuana use as a precipitant for clinical events. Research directions might include more studies of cardiovascular disease outcomes and relationships of marijuana with cardiovascular risk factors, studies of metabolic and physiologic effects of chronic marijuana use that may affect cardiovascular disease risk, increased understanding of the role of the cannabinoid receptor system in cardiovascular regulation, and studies to determine if there is a therapeutic role for cannabinoids in blood pressure control or for neuroprotection after stroke.

Clinical consequences of marijuana

JH Khalsa, S Genser, H Francis, and B Martin
The Journal of Clinical Pharmacology, 2002; 42:7-10
http://jcp.sagepub.com/cgi/content/abstract/42/11_suppl/7S

As documented in national surveys, for the past several years, marijuana has been the most commonly abused drug in the United States, with approximately 6% of the population 12 years and older having used the drug in the month prior to interview. The use of marijuana is not without significant health hazards. Marijuana is associated with effects on almost every organ system in the body, ranging from the central nervous system to the cardiovascular, endocrine, respiratory/pulmonary, and immune systems. Research presented in this special supplement will show that in addition to marijuana abuse/dependence, marijuana use is associated in some studies with impairment of cognitive function in the young and old, fetal and developmental consequences, cardiovascular effects (heart rate and blood pressure changes), respiratory/pulmonary complications such as chronic cough and emphysema, impaired immune function leading to vulnerability to and increased infections, and the risk of developing head, neck, and/or lung cancer. In general, acute effects are better studied than those of chronic use, and more studies are needed that focus on disentangling effects of marijuana from those of other drugs and adverse environmental conditions.

The residual cognitive effects of heavy marijuana use in college students.

Pope HG Jr, Yurgelun-Todd D.
JAMA. 1996 Feb 21;275(7):521-7.
http://jama.ama-assn.org/cgi/content/abstract/275/7/521

OBJECTIVE: To assess whether frequent marijuana use is associated with residual neuropsychological effects. DESIGN: Single-blind comparison of regular users vs infrequent users of marijuana. PARTICIPANTS: Two samples of college undergraduates: 65 heavy users, who had smoked marijuana a median of 29 days in the last 30 days (range, 22 to 30 days) and who also displayed cannabinoids in their urine, and 64 light users, who had smoked a median of 1 day in the last 30 days (range, 0 to 9 days) and who displayed no urinary cannabinoids. INTERVENTION: Subjects arrived at 2 PM on day 1 of their study visit, then remained at our center overnight under supervision. Neuropsychological tests were administered to all subjects starting at 9 AM on day 2. Thus, all subjects were abstinent from marijuana and other drugs for a minimum of 19 hours before testing. MAIN OUTCOME MEASURES: Subjects received a battery of standard neuropsychological tests to assess general intellectual functioning, abstraction ability, sustained attention, verbal fluency, and ability to learn and recall new verbal and visuospatial information. RESULTS: Heavy users displayed significantly greater impairment than light users on attention/executive functions, as evidenced particularly by greater perseverations on card sorting and reduced learning of word lists. These differences remained after controlling for potential confounding variables, such as estimated levels of premorbid cognitive functioning, and for use of alcohol and other substances in the two groups. CONCLUSIONS: Heavy marijuana use is associated with residual neuropsychological effects even after a day of supervised abstinence from the drug. However, the question remains open as to whether this impairment is due to a residue of drug in the brain, a withdrawal effect from the drug, or a frank neurotoxic effect of the drug.

Neuropsychological deficits in long-term frequent cannabis users

Lambros Messinis, PhD, Anthoula Kyprianidou, BSc, Sonia Malefaki, PhD and Panagiotis Papathanasopoulos, MD, PhD
NEUROLOGY 2006;66:737-739
http://www.neurology.org/cgi/content/abstract/66/5/737

The authors examined neuropsychological functioning in 20 long-term (LT), 20 shorter term (ST) heavy frequent cannabis users, and 24 controls after abstinence for ≥24 hours prior to testing. LT users performed significantly worse on verbal memory and psychomotor speed. LT and ST users had a higher proportion of deficits on verbal fluency, verbal memory, attention, and psychomotor speed. Specific cognitive domains appear to deteriorate with increasing years of heavy frequent cannabis use.

Repeated cannabinoid exposure during perinatal, adolescent or early adult ages produces similar longlasting deficits in object recognition and reduced social interaction in rats

Melanie O'Shea, Iain S. McGregor, Paul E. Mallet
Journal of Psychopharmacology, Vol. 20, No. 5, 611-621 (2006)
http://dx.doi.org/10.1177/0269881106065188

There is mounting evidence that chronic cannabis use might result in lasting neurobehavioural changes, although it remains unclear whether vulnerability diminishes with age. The current study compared the effects of cannabinoid exposure at three developmental periods on subsequent measures of memory and anxiety. Male rats aged 4 days (perinatal), 30 days (adolescent) and 56 days (young adult) were injected with vehicle or incremental doses of the cannabinoid receptor agonist CP 55940, daily for 21 consecutive days (0.15, 0.20 or 0.30mg/kg for 7 days per dose, respectively). Following a 28-day drug-free period, working memory was assessed in an object recognition task. One week later, social anxiety was assessed in a social interaction test. Two days later, generalized anxiety was assessed in an emergence test. Results revealed that CP 55940 impaired working memory and social interaction similarly at all three ages. CP 55940 had no effects in five of six emergence test measures, but a modest but significant reduction in anxiety was noted in one measure following adolescent exposure. We conclude that chronic cannabinoid exposure leads to long-term memory impairments and increased anxiety, irrespective of the age at which drug exposure occurrs.

Cannabis, Cognition, and Residual Confounding

Harrison G. Pope, Jr, MD
JAMA. 2002;287:1172-1174.
http://jama.ama-assn.org/cgi/content/extract/287/9/1172

In this issue of THE JOURNAL, Solowij and colleagues1 report a variety of neuropsychological deficits in long-term cannabis users who were tested a median of 17 hours after their last reported cannabis intake. Their findings of impairments in memory and attention are not surprising since several large and well-controlled studies have found similar deficits on neuropsychological tests administered to long-term cannabis users after 12 to 72 hours of abstinence.2-5 If these deficits are brief and reversible (ie, due to a residue of cannabinoids lingering in the brain or to withdrawal effects from abruptly stopping the drug), they might not be a serious threat. However, if these deficits are prolonged or irreversible (ie, due to neurotoxicity from years of cumulative cannabis exposure), they become a matter of grave concern. The findings of Solowij and colleagues favor the latter possibility in that longer-term...
[you'll want to check this one out full-text, so just pull it up on-campus, and save it to the computer in .pdf format, and email it to yourself]

Marijuana use is associated with a reorganized visual-attention network and cerebellar hypoactivation

L. Chang, R. Yakupov, C. Cloak and T. Ernst
Brain 2006 129(5):1096-1112;
http://dx.doi.org/10.1093/brain/awl064
http://brain.oxfordjournals.org/cgi/content/abstract/129/5/1096

Attention and memory deficits have been reported in heavy marijuana users, but these effects may be reversible after prolonged abstinence. It remains unclear whether the reversibility of these cognitive deficits indicates that chronic marijuana use does not alter cortical networks, or that such changes occur but the brain adapts to the drug-induced changes. Blood oxygenation-level dependent (BOLD) functional MRI (fMRI) was performed in 24 chronic marijuana users (12 abstinent and 12 active) and 19 age-, sex- and education-matched control subjects during a set of visual-attention tasks with graded levels of difficulty. Neuropsychological tests were also administered on each subject. The two marijuana user groups showed no significant difference in usage pattern (frequency or duration of use, age of first use, cumulative joints used, averaged >2000 joints) or estimated cumulative lifetime exposure of {Delta}-9-tetrahydrocannabinol (THC) (mean 168 ± 45 versus 244 ± 135 g). Despite similar task and cognitive test performance compared with control subjects, active and abstinent marijuana users showed decreased activation in the right prefrontal, medial and dorsal parietal, and medial cerebellar regions, but greater activation in various frontal, parietal and occipital brain regions during the visual-attention tasks (all with P ≤ 0.001, corrected, cluster level). However, the BOLD signals in the right frontal and medial cerebellar regions normalized with duration of abstinence in the abstinent users. Active marijuana users, with positive urine tests for THC, showed greater activation in the frontal and medial cerebellar regions than abstinent marijuana users and greater usage of the reserve network (regions with load effect), suggesting a neuroadaptive state. Both earlier age of first use and greater estimated cumulative dose of THC exposure were related to lower BOLD signals in the right prefrontal region and medial cerebellum. The altered BOLD activation pattern in the attention network and hypoactivation of the cerebellum suggest neuroadaptive processes or alteration of brain development in chronic marijuana users. These changes also may be related to marijuana-induced alteration in resting cerebral blood volume/flow or downregulation of cannabinoid (CB1) receptors. The greater activation in the active compared with abstinent marijuana users demonstrates a neuroadaptive state in the setting of active marijuana use, while the long-term chronic effect of marijuana on the altered brain network may be reversible with prolonged abstinence.

Cognitive Functioning of Long-term Heavy Cannabis Users Seeking Treatment

Nadia Solowij, PhD; Robert S. Stephens, PhD; Roger A. Roffman, DSW; Thomas Babor, PhD, MPH; Ronald Kadden, PhD; Michael Miller, PhD; Kenneth Christiansen, PsyD; Bonnie McRee, MPH; Janice Vendetti, MPH; for the Marijuana Treatment Project Research Group
JAMA. 2002;287:1123-1131.
http://jama.ama-assn.org/cgi/content/abstract/287/9/1123

Context: Cognitive impairments are associated with long-term cannabis use, but the parameters of use that contribute to impairments and the nature and endurance of cognitive dysfunction remain uncertain.
Objective: To examine the effects of duration of cannabis use on specific areas of cognitive functioning among users seeking treatment for cannabis dependence.
Design, Setting, and Participants: Multisite retrospective cross-sectional neuropsychological study conducted in the United States (Seattle, Wash; Farmington, Conn; and Miami, Fla) between 1997 and 2000 among 102 near-daily cannabis users (51 long-term users: mean, 23.9 years of use; 51 shorter-term users: mean, 10.2 years of use) compared with 33 nonuser controls.
Main Outcome Measures: Measures from 9 standard neuropsychological tests that assessed attention, memory, and executive functioning, and were administered prior to entry to a treatment program and following a median 17-hour abstinence.
Results: Long-term cannabis users performed significantly less well than shorter-term users and controls on tests of memory and attention. On the Rey Auditory Verbal Learning Test, long-term users recalled significantly fewer words than either shorter-term users (P = .001) or controls (P = .005); there was no difference between shorter-term users and controls. Long-term users showed impaired learning (P = .007), retention (P = .003), and retrieval (P = .002) compared with controls. Both user groups performed poorly on a time estimation task (P<.001 vs controls). Performance measures often correlated significantly with the duration of cannabis use, being worse with increasing years of use, but were unrelated to withdrawal symptoms and persisted after controlling for recent cannabis use and other drug use. Conclusions: These results confirm that long-term heavy cannabis users show impairments in memory and attention that endure beyond the period of intoxication and worsen with increasing years of regular cannabis use.

I'm sending a link of these studies to all of the people I know who I suspect would have more than an academic and impersonal interest in the findings...mom, dad, the sister, Mr. John P. Mitchell, of 3011 W. Northbury Lane, 222-1144 [just a joke].
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Technorati tags: Marijuana

Around the Blogzone

A short review of some good stuff:

• Review of AA Programs

The NY Times has an article on the failure of AA programs. Being familiar with drug abusers and programs like Teen Challenge, I am not surprised at all by this report. I'm not knocking it for those for whom it works, but it is clearly a para-church, and ought to be supplanted with secular alternatives like the SOS program. I am living proof that the AA creed/motto "moderate drinking is impossible" (echoed from the AA/NA) is false. Those who say you are completely unable to alter your actions and become capable of self-restraint are wrong. From the article:

And no data showed that 12-step interventions were any more — or any less — successful in increasing the number of people who stayed in treatment or reducing the number who relapsed after being sober...

“A.A. has helped a lot of people,” Dr. Nunes said. “There are a lot of satisfied customers. On the basis of that, we have to take it seriously.”

• Ouch. Poor Disco Institute...

Barbara Forrest absolutely demolishes ID in her new CSISOP article "The 'Vise Strategy' Undone."

• Oh the irony

Mel Gibson more than apologizes as he tries to convince the world that he doesn't share the anti-semitic views of his father, Hutton Gibson. Ed Brayton had this hilarious bit to say,

ABC, in a stunningly obvious move, has pulled the plug on a forthcoming Mel Gibson-directed miniseries on the holocaust. No word on whether they will also be cancelling David Duke's series about slavery or Osama Bin Laden's documentary on the evils of religious extremism.

• Six days for God, Six days for Israel

Massimo Pigliucci has a great summary of his thoughts on the mess in the Middle East, and I have to say I agree with his views on this matter nearly to a "t". Will the War of '67 start again?

• No Fan of the "Christ Myth"

Gary Habermas has a critique of the work of G.A. Wells. Wells is a well-known writer on the question of "Christ-myth" -- which denies that Jesus was a historical figure. I tend to agree with mainstream historians and scholars that a real person either named Jesus or re-named Jesus by his followers existed, around whom the myths of the Christ were constructed. While some of the elements of the Jesus stories are certainly borrowed from previous myths, the evidence just doesn't yet support his personhood being a total myth.
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Technorati tags: Blogosphere