The Other Side of Cannabis

Photo by Daniel Páscoa on Unsplash

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The following article is courtesy of the Pain News Network

I knew from my friend Nick’s Facebook feed that he was a cannabis enthusiast. His posts preached how it cures pretty much everything and will lead us to world peace.

Nick never tired of encouraging me to try it for my pain from Ehlers-Danlos Syndrome, even as I explained repeatedly that since my mother was psychotic, I avoid all drugs which may cause psychosis. Theoretically, I am at higher risk for that adverse reaction.

Psychosis is a disconnection from reality. A person may have delusions, hallucinations, talk incoherently and experience agitation. Since the 1970s, researchers have been investigating whether cannabis can trigger a psychotic break or full-blown schizophrenia. Daily users of highly potent cannabis are five times more likely to develop psychosis. The risk comes not only from genetic factors, but also from early-life neglect or abuse and even being born in the winter.

Having a rare and complicated medical condition, I get a lot of advice. I took Nick’s insistence I go on cannabis as kindness, as I take all unsolicited health tips. Our social media friendship grew. When my husband and I took a trip to his part of the world, he invited us to stay with him.

Nick picked us up at the train station in the English countryside looking like a dashing movie star. Slim and trim in a crisp Oxford shirt and Ray Bans, spryly maneuvering our luggage, he was still attractive in his 70s. Speaking English like Prince Charles, he confessed, “I am actually a cannabis farmer. I expect no trouble from the local police, but would you prefer to get a hotel room in town?”

My husband and I once risked our lives in the back alleys of Hong Kong to get me a fake Hermes bag. We did not need to consult with each other. We opt for adventure. I would not miss my chance to live a Jane Austen fantasy.

We ate off Nick’s three centuries-old family silver, the forks worn down from hundreds of years of scooting food across the plate. We sat beneath the Regency era portraits of his ancestors. Nick had a room devoted to his cannabis crop, growing fast underneath sun simulating lamps. The odor from the plants permeated his entire country home.

In real life, just as on Facebook, Nick’s favorite subject was the virtues of cannabis. He had been using it since he was a young man. Decades ago, he had spent a couple of years in prison for distribution. Recently his wife had left him over his devotion to marijuana. It was clear from Nick’s stories and life choices that cannabis had created tremendous tension with his family.

We talked of him coming to stay with us in Los Angeles, how we could all go to San Francisco to visit the Haight, as Nick was a genuine 1960s hippie. But leaving home to travel was a problem for him. When he does, he has to ask a friend to tend to his plants, which also means asking the friend to break the law.

Our days with Nick at his charming cottage were governed by his need to partake. Our visits to local sites were cut short, so he could be done driving and functioning for the day, and get home to get high. He did not seem to enjoy the excursions and seemed overwhelmed by being out and about, his anxiety growing, urging us to wrap up and get back home.

Cannabis Side Effects

Like Nick, many people are certain that marijuana helps them get by. On it, life is tolerable and pleasant. Anxiety is calmed. They are out of pain and able to sleep. But are they really benefiting?

At first, marijuana has a calming effect, but over time it negatively changes the way the brain works, causing anxiety, depression and impaired social functioning. With regular use, memory, learning, attention, decision-making, coordination, emotions, and reaction time are impaired. Heavy cannabis use lowers IQ

This damage can persist, even after use stops. Teenage users are more likely to experience anxiety, depression and suicidality in young adulthood. According to the CDC, about 1 in 10 marijuana users will become addicted. For people who begin using younger than age 18, 1 in 6 become addicted.

As is the case with other mood-altering substances, cannabis withdrawal symptoms — which include irritability, nervousness, anxiety, depression, insomnia, loss of appetite, abdominal pain, shakiness, sweating, fever, chills and headache — provokes the desire to use.

If someone is using cannabis to escape emotional distress, they never get the chance to deal with underlying problems. Psychiatrist Dr. David Puder recommends to his patients on cannabis that they stop in order to benefit from therapy.

“When they are off of marijuana, they have the ability to be present and really process what they will need to process in therapy in order to get over anxiety and depression,” Puder says, noting that users will often experience a flood of emotions and memories once they stop.

Medical marijuana has been approved for chronic pain and over 50 other health conditions by various states. Whether it actually helps with pain is uncertain. The U.S. Surgeon General warns the potency of marijuana has changed over time and what is available today is much stronger than previous versions. Higher doses of THC (the psychoactive chemical in cannabis) are more likely to produce anxiety, agitation, paranoia and psychosis. Consumers are not adequately warned about these potential harms.

House Guests

Our friend Nick was sure his marijuana use was his choice and that he was not addicted. He insisted my husband and I get high with him.

What is a polite house guest to do? Go along, of course, although we prefer whiskey and a steak. Nick promised we would love it, and that we were free to go upstairs and have sex and open up about anything. We giggled awkwardly. I ingested the smallest possible dose.

Nick then got higher than we had seen him during our entire visit, wolfing down his dinner in minutes. Then, after promising we’d have a tremendous evening of emotional openness and transcendent sharing, he burst into tears recounting how he was the victim of violence in his youth.

I felt for him, it was a horrifying event. Was this unresolved trauma the cause of a lifetime of drug use, denial and self-isolation? We had to wonder. It was truly awkward and uncomfortable, but Nick didn’t seem to remember his outburst. When we returned home, he continued to hound me to take up cannabis.

By Madora Pennington, PNN Columnist

Pandemic effects the Illicit Drug Supply

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Editors note: This is an excerpt from the most recent UN report on International Drug Traffic.

The COVID-19 crisis is taking its toll on the global economy, public health and our way of life. The virus has now infected more than 3.6 million people worldwide, killed 250,000 and led Governments to take drastic measures to limit the spread of coronavirus disease 2019. Roughly half of the global population is living under mobility restrictions, international border crossings have been closed and economic activity has declined drastically, as many countries have opted for the closure of nonessential businesses.
Drug trafficking relies heavily on legal trade to camouflage its activities and on individuals being able to distribute drugs to consumers. The measures implemented by Governments to counter the COVID19 pandemic have thus inevitably affected all aspects of the illegal drug markets, from the production and trafficking of drugs to their consumption.
Having said that, the impact of those measures varies both in terms of the different business models used in the distribution of each type of drug and the approaches used by different countries to address the pandemic. These range from the closure of international border crossings, while allowing domestic travel, to moderate-to-strict shelter-in-place orders, or a complete lockdown of all activities, including suspension of essential services other than for emergencies. The impact on actual drug production may vary greatly depending on the substance and the geographical location of its production.
Based on the most recent data from government authorities, open sources, including the media, and the network of UNODC field offices, the evidence available suggests the following ongoing dynamics in the impact of the COVID-19 pandemic on the illicit drug markets.
Measures implemented to prevent the spread of COVID-19 are having a mixed impact on the drug supply chain The impact of the measures implemented to address the COVID-19 pandemic appears to have been most homogenous to date at the very end of the drug supply chain, in the destination markets. Many countries across all regions have reported an overall shortage of numerous types of drugs at the retail level, as well as increases in prices, reductions in purity and that drug users have consequently been switching substance (for example, from heroin to synthetic opioids) and/or increasingly accessing drug treatment. Some countries in the Balkans and in the Middle East, where measures are not so strict during the day, have, however, reported less disruption.
The overall impact on bulk supply is reportedly more heterogenous, both across drugs and across countries. Increased controls resulting from the implementation of measures to fight the spread of COVID-19 have had double-edged consequences on large-scale drug supply. Some countries, such as Italy and countries in Central Asia, have experienced a sharp decrease in drug seizures. Other countries, such as Niger, have reported a cease in drug trafficking. There have also been reports of organized criminal groups involved in drug trafficking becoming distracted from their usual illicit activities by emerging crime linked to the COVID-19 pandemic; for example, cybercrime and trafficking in falsified medicines in the Balkan countries.
On the other hand, other countries, including the Islamic Republic of Iran and Morocco, have reported large drug seizures, indicating that large-scale drug trafficking is still taking place, and some have reported an increase in interdiction resulting from increased controls. An example of an increase in drug enforcement is seen in the United Kingdom of Great Britain and Northern Ireland, where an improvement in the interdiction of “county lines” activities, a trafficking modus operandi particular to COVID-19 and the drug supply chain: from production and trafficking to use
that country in which young disadvantaged people are exploited, has been reported. “Fortuitous” drug interceptions in countries such as Egypt have also resulted in mid-scale drug seizures made during street controls, and reports from Nigeria indicate continued drug trafficking, with a possible increase
in the use of postal services.

Pandemic and Panic

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Editors Note: This is part two of the most recent UN report on international drug use.

Drug shortages have been reported and could have negative health consequences for people with drug use disorders
Many countries have reported drug shortages at the retail level, with reports of heroin shortages in Europe, South-West Asia and North America in particular. Drug supply shortages can go together with an overall decrease in consumption (for example, of drugs that are mostly consumed in recreational
setting such as bars and clubs) but may also, especially in the case of heroin, lead to the consumption of harmful domestically-produced substances, as well as more harmful patterns of drug use by people with drug use disorders. In terms of alternatives, some countries in Europe have warned that heroin
users may switch to substances such as fentanyl and its derivatives. An increase in the use of pharmaceutical products such as benzodiazepines and buprenorphine has also been reported, to the extent that their price has doubled in some areas.
Harmful patterns deriving from drug shortages include an increase in injecting drug use and the sharing of injecting equipment and other drug paraphernalia, all of which carry the risk of spreading blood-borne diseases, such as HIV/AIDS and hepatitis C, and COVID-19 itself. Risks resulting from drug overdose may also increase among people who inject drugs and who are infected with COVID-19.
Some countries have reported that the activities of organizations providing support to people who use drugs have been severely affected. In response to a reduction in the accessibility of treatment service provision during the lockdown, some countries have increased low-threshold services and reduced barriers for obtaining opiate-substitution medication; for example, allowing pharmacies to dispense methadone, as in the United Kingdom. Other countries, however, have reported difficulties in maintaining services for drug users.
Economic difficulties caused by COVID-19 could change drug consumption for the worse In the long run, the economic downturn caused by the COVID-19 crisis has the potential to lead to a lasting transformation of the drug markets. The economic difficulties caused by the COVID-19 crisis may affect people who are already in a position of socioeconomic disadvantage harder than others.
This could lead to an increase in the number of people resorting to illicit activities linked to drugs in order to make a living (production, transport, etc.) and/or being recruited into drug trafficking organizations.
Based on the experiences of the economic crisis of 2008, it is fair to assume that the economic downturn may lead to reductions in drug-related budgets among Member States, an overall increase in drug use, with a shift towards cheaper drugs, and a shift in patterns of use towards injecting drugs and to substances with an increased risk of harm due to a greater frequency of injections.

Know the Risks of Meth

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Methamphetamine (meth) is a powerful, highly addictive drug that causes devastating health effects, and sometimes death, even on the first try.

Meth is easy to get addicted to and hard to recover from. Meth is a dangerous, synthetic, stimulant drug often used in combination with other substances that can be smoked, injected, snorted, or taken orally. Someone using meth may experience a temporary sense of heightened euphoria, alertness, and energy. But using meth changes how the brain works and speeds up the body’s systems to dangerous, and sometimes lethal, levels—increasing heart rate, blood pressure, body temperature, and respiratory rate. Chronic meth users also experience anxiety, confusion, insomnia, paranoia, aggression, visual and auditory hallucinations, mood disturbances, and delusions.

The Rise of Meth Use in the United States

The number of fatal overdoses involving meth has more than tripled (PDF | 336 KB) between 2011 and 2016, according to the CDC. Use is also on the rise between 2016-2018 for most age groups. In 2018, more than 106,000 adults aged 26 or older used meth—a 43 percent increase over the previous year.

Short-term Effects of Meth

Even taking small amounts of meth, or just trying it once, can cause harmful health effects, including:

  • Increased blood pressure and body temperature
  • Faster breathing
  • Rapid or irregular heartbeat
  • Loss of appetite, disturbed sleep patterns, or nausea
  • Bizarre, erratic, aggressive, irritable, or violent behavior

Long-term Health Risks of Meth

Chronic meth use leads to many damaging, long-term health effects, even when users stop taking meth, including:

  • Permanent damage to the heart and brain
  • High blood pressure leading to heart attacks, strokes, and death
  • Liver, kidney, and lung damage
  • Anxiety, confusion, or insomnia
  • Paranoia, hallucinations, mood disturbances, delusions, or violent behavior (psychotic symptoms can sometimes last for months or years after quitting meth)
  • Intense itching, causing skin sores from scratching
  • Severe dental problems (“meth mouth”)

COVID-19: Potential Implications for Individuals with Substance Use Disorders

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As people across the U.S. and the rest of the world contend with coronavirus disease 2019 (COVID-19), the research community should be alert to the possibility that it could hit some populations with substance use disorders (SUDs) particularly hard. Because it attacks the lungs, the coronavirus that causes COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape. People with opioid use disorder (OUD) and methamphetamine use disorder may also be vulnerable due to those drugs’ effects on respiratory and pulmonary health. Additionally, individuals with a substance use disorder are more likely to experience homelessness or incarceration than those in the general population, and these circumstances pose unique challenges regarding transmission of the virus that causes COVID-19. All these possibilities should be a focus of active surveillance as we work to understand this emerging health threat.NIH has posted a compilation of updates for applicants and grantees, including a Guide Notice on administrative flexibilities and accompanying FAQs.

SARS-CoV-2, the virus that causes COVID-19 is believed to have jumped species from other mammals (likely bats) to first infect humans in Wuhan, capital of China’s Hubei province, in late 2019. It attacks the respiratory tract and appears to have a higher fatality rate than seasonal influenza. The exact fatality rate is still unknown, since it depends on the number of undiagnosed and asymptomatic cases, and further analyses are needed to determine those figures. Thus far, deaths and serious illness from COVID-19 seem concentrated among those who are older and who have underlying health issues, such as diabetes, cancer, and respiratory conditions. It is therefore reasonable to be concerned that compromised lung function or lung disease related to smoking history, such as chronic obstructive pulmonary disease (COPD), could put people at risk for serious complications of COVID-19.

Co-occurring conditions including COPD, cardiovascular disease, and other respiratory diseases have been found to worsen prognosis in patients with other coronaviruses that affect the respiratory system, such as those that cause SARS and MERS. According to a case series published in JAMA based on data from the Chinese Center for Disease Control and Prevention (China CDC), the case fatality rate (CFR) for COVID-19 was 6.3 percent for those with chronic respiratory disease, compared to a CFR of 2.3 percent overall. In China, 52.9 percent of men smoke, in contrast to just 2.4 percent of women; further analysis of the emerging COVID-19 data from China could help determine if this disparity is contributing to the higher mortality observed in men compared to women, as reported by China CDC. While data thus far are preliminary, they do highlight the need for further research to clarify the role of underlying illness and other factors in susceptibility to COVID-19 and its clinical course.

Vaping, like smoking, may also harm lung health. Whether it can lead to COPD is still unknown, but emerging evidence suggests that exposure to aerosols from e-cigarettes harms the cells of the lung and diminishes the ability to respond to infection. In one NIH-supported study, for instance, influenza virus-infected mice exposed to these aerosols had enhanced tissue damage and inflammation.

People who use opioids at high doses medically or who have OUD face separate challenges to their respiratory health. Since opioids act in the brainstem to slow breathing, their use not only puts the user at risk of life-threatening or fatal overdose, it may also cause a harmful decrease in oxygen in the blood (hypoxemia). Lack of oxygen can be especially damaging to the brain; while brain cells can withstand short periods of low oxygen, they can suffer damage when this state persists. Chronic respiratory disease is already known to increase overdose mortality risk among people taking opioids, and thus diminished lung capacity from COVID-19 could similarly endanger this population.

A history of methamphetamine use may also put people at risk. Methamphetamine constricts the blood vessels, which is one of the properties that contributes to pulmonary damage and pulmonary hypertension in people who use it. Clinicians should be prepared to monitor the possible adverse effects of methamphetamine use, the prevalence of which is increasing in our country, when treating those with COVID-19.  

Other risks for people with substance use disorders include decreased access to health care, housing insecurity, and greater likelihood for incarceration. Limited access to health care places people with addiction at greater risk for many illnesses, but if hospitals and clinics are pushed to their capacity, it could be that people with addiction—who are already stigmatized and underserved by the healthcare system—will experience even greater barriers to treatment for COVID-19.  Homelessness or incarceration can expose people to environments where they are in close contact with others who might also be at higher risk for infections. The prospect of self-quarantine and other public health measures may also disrupt access to syringe services, medications, and other support needed by people with OUD.  

We know very little right now about COVID-19 and even less about its intersection with substance use disorders. But we can make educated guesses based on past experience that people with compromised health due to smoking or vaping and people with opioid, methamphetamine, cannabis, and other substance use disorders could find themselves at increased risk of COVID-19 and its more serious complications—for multiple physiological and social/environmental reasons. The research community should thus be alert to associations between COVID-19 case severity/mortality and substance use, smoking or vaping history, and smoking- or vaping-related lung disease. We must also ensure that patients with substance use disorders are not discriminated against if a rise in COVID-19 cases places added burden on our healthcare system. 

As we strive to confront the major health challenges of opioid and other drug overdoses—and now the rising infections with COVID-19—NIDA encourages researchers to request supplements that will allow them to obtain data on the risks for COVID-19 in individuals experiencing substance use disorders.

Finland Ends Homelessness

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In Finland, the number of homeless people has fallen sharply. The reason: The country applies the “Housing First” concept. Those affected by homelessness receive a small apartment and counselling – without any preconditions. 4 out of 5 people affected thus make their way back into a stable life. And: All this is cheaper than accepting homelessness.

Finland is the only country in Europe where homelessness is in decline

In 2008 you could see tent villages and huts standing between trees in the parks of Helsinki. Homeless people had built makeshift homes in the middle of Finland’s capital city. They were exposed to harsh weather conditions.

Since the 1980s, Finnish governments had been trying to reduce homelessness. Short-term shelters were built. However, long-term homeless people were still left out. There were too few emergency shelters and many affected people did not manage to get out of homelessness: They couldn’t find jobs – without a housing address. And without any job, they couldn’t find a flat. It was a vicious circle. Furthermore, they had problems applying for social benefits. All in all, homeless people found themselves trapped.

But in 2008 the Finnish government introduced a new policy for the homeless: It started implementing the “Housing First” concept. Since then the number of people affected has fallen sharply.

Finland has set itself a target: Nobody should have to live on the streets – every citizen should have a residence.

And the country is successful: It is the only EU-country where the number of homeless people is declining.

How everyone is given residence in Finland

It is NGOs such as the “Y-Foundation” that provide housing for people in need. They take care of the construction themselves, buy flats on the private housing market and renovate existing flats. The apartments have one to two rooms. In addition to that, former emergency shelters have been converted into apartments in order to offer long-term housing.

“It was clear to everyone that the old system wasn’t working; we needed radical change,” says Juha Kaakinen, Director of the Y-Foundation.

Homeless people turn into tenants with a tenancy agreement. They also have to pay rent and operating costs. Social workers, who have offices in the residential buildings, help with financial issues such as applications for social benefits.

Juha Kaakinen is head of the Y-Foundation. The NGO receives discounted loans from the state to buy housing. Additionally, social workers caring for the homeless and future tenants are paid by the state. The Finnish lottery, on the other hand, supports the NGO when it buys apartments on the private housing market. The Y-Foundation also receives regular loans from banks. The NGO later uses the rental income to repay the loans.

“We had to get rid of the night shelters and short-term hostels we still had back then. They had a very long history in Finland, and everyone could see they were not getting people out of homelessness. We decided to reverse the assumptions.” (Juha Kaakinen, Director of the Y-Foundation)

That’s how the “Housing First” concept works

The policy applied in Finland is called “HousingFirst”. It reverses conventional homeless aid. More commonly, those affected are expected to look for a job and free themselves from their psychological problems or addictions. Only then they get help in finding accommodation.

“Housing First”, on the other hand, reverses the path: Homeless people get a flat – without any preconditions. Social workers help them with applications for social benefits and are available for counselling in general. In such a new, secure situation, it is easier for those affected to find a job and take care of their physical and mental health.

The result is impressive: 4 out of 5 homeless people will be able to keep their flat for a long time with “Housing First” and lead a more stable life.

In the last 10 years, the “Housing First” programme provided 4,600 homes in Finland. In 2017 there were still about 1,900 people living on the streets – but there were enough places for them in emergency shelters so that they at least didn’t have to sleep outside anymore.

Providing people with apartments is cheaper than leaving them on the street

Creating housing for people costs money. In the past 10 years, 270 million euros were spent on the construction, purchase and renovation of housing as part of the “Housing First” programme. However, Juha Kaakinen points out, this is far less than the cost of homelessness itself. Because when people are in emergency situations, emergencies are more frequent: Assaults, injuries, breakdowns. The police, health care and justice systems are more often called upon to step in – and this also costs money.
In comparison, “Housing First” is cheaper than accepting homelessness: Now, the state spends 15,000 euros less per year per homeless person than before.

No miracle cure – but a high success rate

With 4 out of 5 people keeping their flats, “Housing First” is effective in the long run. In 20 percent of the cases, people move out because they prefer to stay with friends or relatives – or because they don’t manage to pay the rent. But even in this case they are not dropped. They can apply again for an apartment and are supported again if they wish.

Of course, there is no guarantee for success. Especially homeless women are more difficult to reach: They conceal their emergency situation more often: They live on the streets less frequently and rather stay with friends or acquaintances.

Original Source/Author: Glösel