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Blowing The Lid Off Of The ‘Marijuana Treatment’ Racket

Reprinted with permission from AlterNet.

According to a comprehensive review by the National Academy of Sciences, Institute of Medicine, “few marijuana users become dependent” upon pot. By contrast, those who drink alcohol are nearly twice as likely to do so problematically. Nonetheless, over half of all young people admitted to drug treatment programs are there for their involvement with marijuana, and this percentage is steadily rising. So what’s going on?

A just-published analysis of federal drug treatment admissions data – knows as TEDS-A (Treatment Episode Data Set – Admissions) – by researchers at Binghamton University and the University of Iowa sheds some light on this issue, and it’s disturbing.

According to the study, which analyzed youth (ages 12 to 20) marijuana treatment admissions during the years 1995 to 2012, both the total number of drug treatment admissions and the number of admissions exclusively for marijuana increased over this 18-year period. Specifically, the number of youth admitted for weed rose from 52,894 in 1995 to 87,528 in 2012 – an increase of 65 percent. (Overall, just under 1.5 million teens were admitted to treatment for alleged cannabis dependence this period.)

Yet, well publicized data from the US Centers for Disease Control, Monitoring the Future, and others reports that daily, monthly, and yearly marijuana use by young people declined sharply during much of this same period. Perhaps even more importantly, studies further report that rates of problematic marijuana – so-called “cannabis use disorder” (CUD) – also fell significantly. For example, data published last week by investigators at the US National Institute of Drug Abuse (NIDA) and the Substance Abuse Mental Health Services Administration (SAMHSA) finds that the prevalence of past year CUD in young people fell 25 percent in the years between 2002 and 2014. Their findings mimicked those of a 2016 NIDA-funded study which similarly reported a 24 percent decline in problematic pot use by young people.

So, if fewer young people are using pot – and even fewer are doing so problematically – why are more teens than ever before winding up in substance abuse treatment programs? The answer lies with the criminal justice system.

Between 1995 and 2012, the percentage of young people referred to drug treatment as a result of a criminal arrest rose 70 percent, researchers reported. As a result, as of 2012, 53 percent of all youth drug treatment admissions came directly from criminal justice referrals. (Among adults, this percentage has historically been even higher.)

Predictably, as the percentage of criminal justice referrals has increased, so too has the percentage of minority youth being coerced into drug treatment programs. (Studies consistently find that African Americans and Hispanics are arrested for drug law violations, and marijuana possession specifically, at rates far greater than whites – even though their drug use rates are little different.) Since 1995, Black youth admitted to drug treatment for marijuana increased 86 percent. The percentage of Latino admissions grew by 256 percent. By contrast, white youth admissions increased only 11 percent during this same time period.

Perhaps most importantly, the authors of this new study acknowledge that many of the teens now being mandated to attend drug treatment don’t appear to belong there because they exhibit little evidence of having suffered from any deleterious mental or physical health problems specific to their cannabis use. In fact, since 2008, 30 percent of all young people in treatment for alleged marijuana dependence had no record of having even used pot in the 30 days prior to their admittance – much less exhibiting signs of being dependent upon the herb. Another 20 percent of the teens admitted had used pot fewer than three times in the past month. “Our findings indicate that the severity of drug use involved in those admissions has decreased,” authors concluded. “This study highlights the importance of identifying youth in actual need of treatment services.”

Indeed. At a time when our nation is in the grip of rising opioid abuse, America’s limited drug treatment services are primarily being used to warehouse those who occasionally use – or, more likely – have been arrested for pot.

Paul Armentano is the deputy director of NORML (National Organization for the Reform of Marijuana Laws) and serves as a senior policy advisor for Freedom Leaf, Inc. He is the co-author of the book, Marijuana Is Safer: So Why Are We Driving People to Drink? (Chelsea Green, 2013).

Researchers Reduce Inflammation In Human Cells, A Major Cause Of Frailty

From Mayo Clinic News Network, Mayo Clinic News Network (TNS)

ROCHESTER, Minn. — Chronic inflammation, closely associated with frailty and age-related diseases, is a hallmark of aging. Mayo Clinic researchers have discovered that inhibiting key enzyme pathways reduces inflammation in human cells in culture dishes and decreases inflammation and frailty in aged mice.

The results appear in Proceedings of the National Academy of Sciences of the United States of America. While further studies are needed, researchers are hopeful that these findings will be a step toward treatments for frailty and other age-related chronic conditions.

In the study, researchers found that Janus kinase (JAK) inhibitors, drugs that work to block activity of JAK enzymes, decreased the factors released by human senescent cells in culture dishes. Senescent cells are cells that contribute to frailty and diseases associated with aging. Also, these same JAK inhibitors reduced inflammatory mediators in mice. Researchers examined aged mice, equivalent to 90-year-old people, before and after JAK inhibitors. Over the course of two months, the researchers found substantial improvement in the physical function of the aged mice, including grip strength, endurance and physical activity.

“One of the things we want to do is find some kind of treatment for this other than prescribing better wheelchairs or walkers, or other kinds of things that we are stuck with now that are Band-Aid solutions,” says Dr. James Kirkland, director of the Mayo Clinic Robert and Arlene Kogod Center on Aging and senior author of the study. A clinical geriatrician, Dr. Kirkland says he sees frailty in many of his elderly patients and that it’s often associated with poor outcomes and functional disability.

“Our goal is not necessarily to increase life span, and certainly not life span at all costs. Our goal is to enhance health span — the period during life when people are independent,” explains Dr. Kirkland. “This drug approach and others we are developing look like they might hold some promise in reaching that goal.”

©2015 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency, LLC

Photo: Mayo Clinic researchers have discovered that inhibiting key enzyme pathways reduces inflammation in human cells in culture dishes and decreases inflammation and frailty in aged mice. Researchers are hopeful that these findings will be a step toward treatments for frailty and other age-related chronic conditions. (Georg Drexel/Peter Atkins/Fotolia/TNS)

Getting Your Blood Pressure Even Lower: Here Are The Risks And Rewards

By Melissa Healy, Los Angeles Times (TNS)

Two months ago, U.S. officials crowed that a federally funded study gauging the impact of stricter blood pressure control had produced such dramatic results, they were bringing the clinical trial to an early close.

On Monday, those dramatic results got medicine’s version of a ticker-tape parade: a research article and not one but three editorials in the New England Journal of Medicine detailed and dissected just how steeply heart disease, strokes and deaths from any cause declined in patients who aimed to get their systolic blood pressure reading to 120 mm of mercury.

The upshot: For people between 50 and 75 who are at higher than usual risk of cardiovascular disease but don’t have diabetes and have not already had a stroke, it’s probably no longer defensible to be satisfied with a systolic blood pressure reading just under 140. (Earlier this year, the American Heart Association and American College of Cardiology set a 140/90 mm reading as the correct goal for most patients under 80 years of age with coronary artery disease.)

But getting all such patients’ systolic blood pressure readings to 120 may not be entirely realistic either, said experts assessing the significance of the study, called SPRINT (Systolic Blood Pressure Intervention Trial).

Many of the 4,678 subjects assigned to shoot for a systolic reading of 120 couldn’t quite make it to that goal, despite an escalation in the number of medications they took and an average increase in such side effects as dizziness, electrolyte abnormalities, and injury to or failure of the kidneys.

Still, the trial’s results suggest the benefits of trying were undeniable.

In a follow-up period of just over three years, people between 50 and 75 who make efforts to get that top reading 20 points below 140 mm of mercury reaped a welter of benefits, researchers revealed: Their likelihood of dying of any cause dropped by 27 percent, and they reduced by roughly 25 percent their likelihood of suffering one of a range of cardiovascular outcomes, including heart attack, stroke, heart failure and acute coronary syndrome.

On average, study physicians had to prescribe 2.8 medications to get a study subject’s systolic blood pressure reading to 121.4. Subjects who were assigned to get their systolic blood pressure reading under 140 took, on average, 1.8 different prescription medications, and their systolic blood pressure reading settled at an average of 136.2.

By a key measure — the “number needed to treat” — of those outcomes made it a pretty easy call to shoot for the lower systolic reading in treating a patient over 50 with high blood pressure.

Study authors reckoned that for every 61 patients medicated to achieve the lower systolic number for just over three years, there would be one less cardiovascular event (a heart attack, stroke, heart failure, acute coronary syndrome or death). For every 90 patients who got the more aggressive treatment, one death from any cause would be averted. To avert a death from cardiovascular causes, 172 patients would need to get the more aggressive treatment for a little over three years.

(To put that number in perspective, it took 83 patients treated with a statin medication for five years to prevent a single death, 39 patients treated with a statin to prevent a single non-fatal heart attack and 125 to prevent a single stroke. Treating 50 people at high risk of cardiovascular disease for a year with clopidogrel, known also as Plavix, has been found to prevent one cardiovascular event. But 333 would have to be treated with Plavix to prevent a single death.)

“This clinical trial will change practice,” wrote four senior NEJM editors, led by Editor in Chief Dr. Jeffrey M. Drazen.

But whether physicians should accept a systolic reading of 120 as a rigid and immediate requirement was not so clear.

“In my opinion, the results from SPRINT warrant reducing the treatment goal for systolic blood pressure to less than 130 mm HG” in most hypertensives over 50 with no history of stroke and no diabetes, wrote Dr. Aram V. Chobanian, a cardiologist, blood pressure researcher and former dean of the Boston University School of Medicine.

Even if the systolic target were reduced to that interim level, wrote Chobanian, a majority of Americans with hypertension would be considered to have “uncontrolled” high blood pressure. And physicians, he added, know all too well that when they must prescribe more than two medications to bring blood pressure under control, patients are less likely to stick to their medication regimen.

The SPRINT study, wrote Vlado Perkovic and Anthony Rodgers in an invited editorial, “redefines blood-pressure target goals and challenges us to improve blood-pressure management.” Despite its name, however, the SPRINT study cannot change treatment overnight, they added.

©2015 Los Angeles Times. Distributed by Tribune Content Agency, LLC.

Photo: Quinn Dombrowski via Flickr

 

Another Ebola Challenge: Disposing Of Medical Waste

By Monte Morin, Los Angeles Times

A single Ebola patient treated in a U.S. hospital will generate eight 55-gallon barrels of medical waste each day.
Protective gloves, gowns, masks and booties are donned and doffed by all who approach the patient’s bedside and then discarded. Disposable medical instruments, packaging, bed linens, cups, plates, tissues, towels, pillowcases, and anything that is used to clean up after the patient must be thrown away.
Even curtains, privacy screens, and mattresses eventually must be treated as contaminated medical waste and disposed of.
Dealing with this collection of pathogen-filled debris without triggering new infections is a legal and logistical challenge for every U.S. hospital now preparing for a potential visit by the virus.
In California and other states, it is an even worse waste-management nightmare.
While the U.S. Centers for Disease Control and Prevention recommend autoclaving (a form of sterilizing) or incinerating the waste as a surefire means of destroying the microbes, burning infected waste is effectively prohibited in California, and banned in several other states.
“Storage, transportation, and disposal of this waste will be a major problem,” California Hospital Association President C. Duane Dauner warned U.S. Sen. Barbara Boxer, D-Calif., in a letter last week.
Even some states that normally permit incineration are throwing up barriers to Ebola waste.
In Missouri, the state attorney general has sought to bar Ebola-contaminated debris from a St. Louis incinerator operated by Stericycle Inc., the nation’s largest medical waste disposal company.
Due to restrictions on burning, California hospital representatives say their only option appears to be trucking the waste over public highways and incinerating it in another state — a prospect that makes some environmental advocates uneasy.
Under federal transportation guidelines, the material would be designated a Class A infectious substance, or one that is capable of causing death or permanent disability, and would require special approval from the Department of Transportation, hospital representatives say.
“These are some pretty big issues and they need some quick attention,” said Jennifer Bayer, spokeswoman for the Hospital Association of Southern California.
“We fully expect that it’s coming our way,” Bayer said of the virus. “Not to create any sort of scare, but just given the makeup of our population and the hub that we are. It’s very likely.”
The Ebola virus is essentially a string of genetic material wrapped in a protein jacket. It cannot survive a 1,500-degree scorching within an incinerator, or the prolonged, pressurized steam of an autoclave.
“The Ebola virus itself is not particularly hardy,” CDC Director Dr. Thomas Frieden said under questioning on Capitol Hill recently. “It’s killed by bleach, by autoclaving, by a variety of chemicals.”
However, CDC guidelines note that “chemical inactivation” has yet to be standardized and could trigger worker safety regulations.
California health officials recently tried to reassure residents that the state’s private and public hospitals were up to the task and were actively training for the possible arrival of Ebola.
“Ebola does not pose a significant public health risk to California communities at the present time,” said Dr. Gil Chavez, an epidemiologist and deputy director at the California Department of Public Health. “Let me tell you why: Current scientific evidence specifies that people cannot get Ebola through the air, foo,d or water. … The Ebola virus does not survive more than a few hours on impervious surfaces.”
It was unclear whether California officials viewed the waste issue as a potential problem.
Although a third of the state’s private hospitals and “a few” of its public hospitals reported to Boxer’s office that there would be problems complying with the CDC’s incineration recommendation, and others, a state public health official told reporters he was not aware of any conflicts.
Dr. David Perrott, chief medical officer for the California Hospital Association, said there was also confusion about whether infected human waste could be flushed down the toilet.
“Here’s what we’ve heard from the CDC: It’s OK,” Perrott said. “But then we’ve heard from some sources, that maybe we need to sterilize it somehow and then flush it down the toilet or you have to check with local authorities. It sounds maybe a little gross, but there is a real question about what to do with that waste.”
Dr. Thomas Ksiazek, a professor of microbiology and immunology of the University of Texas Medical Branch, has said he believes there’s been a lot of overreaction on the topic of Ebola medical waste.
“There are other ways to deal with the waste; autoclaving would be chief among them,” Ksiazek said. “The problem is, most hospitals don’t use it for most disposable items. They’re quite happy to bag them up and send them to a regular medical disposal company.”
But Allen Hershkowitz, a senior scientist at the Natural Resources Defense Council, said incineration is simple and effective, and should be available to hospitals to help dispose of the mountain of waste.
Hershkowitz said states began to crack down on medical waste incineration years ago because many materials that did not need to be burned were being sent to combustors and were emitting dangerous pollutants.
In this case of Ebola medical waste, he said California should reconsider its restrictions.
“There’s no pollutant that’s going to come out of a waste incinerator that’s more dangerous than the Ebola virus,” Hershkowitz said. “When you’re dealing with pathogenic and biological hazards, sometimes the safest thing to do is combustion.”

AFP Photo/Seyllou

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