Prevention in the heroin context

No mention of “prevescalation” in this article, but the concept is there.

Ethical issues surface when we shift to primary prevention.

More evidence of a need for a citizen science approach.

Tennessee solutions?

Prosecute sharers and co-users?

...Michael Malcolm’s younger son was charged in the overdose death of his older brother, with whom he shared drugs purchased on the internet. The cost of prosecution and incarceration, Mr. Malcolm said, would have been better spent on addiction treatment that the family could not afford. “It’s kind of like blaming the leaves on the tree, you know?” he said. “What about the roots?”

NYTimes link to article: Prosecute sharers and co-users?

It is interesting that the article includes case vignettes from Hibbing, Minnesota.

The late addictionologist Nils Bejerot, of Sweden, advocated civil penalties that included sending users to forest camps isolated from drug supplies and difficult to leave on foot. The idea was to separate users from never-users to curb person-to-person sharing. Hibbing might consider thst approachin lieu of prison time. In its nearby Boundary Waters Wilderness Area, it’s possible to get 50 miles into the wilderness with several days of canoeing, and it would be quite difficult to leave on foot or solo, especially if the paddles are in a locked box. Plenty of gih and berries. Cheaper accommodations than a prison or jail.

Civil libertarian thoughts are needed.

Tolerance: something you might have forgotten.

Different Hill functions for different effects (e.g., respiration versus pain relief)

Neuropsychopharmacology in Historical Perspective: Interviews Conducted by Professor Thomas A. Ban

T. Ban, Chapter 1 URL Link

Safe injection sites: Notes during the Opioids Crisis

Link to article:

Is it unethical NOT to provide safe injection equipment under these circumstances?

Opioids: prevention and control during epidemic

San Francisco innovations

Opioid overdose epidemiology

Overdose and safe injection sites in the news:

http://www.chicagotribune.com/news/ct-met-public-bathrooms-opioid-overdose-20180510-story.html

DSM-5 awry?

A. Frances article

postscript:

Can I offer an alternative perspective?

1. Public health requires us to avoid stigmatizing terms. Many people will not walk into a public health facility called “Addiction Services” or “Drug Abuse Services” unless a judge tells them they must do so to avoid a criminal penalty. Why use a term with stigma laden history? We can do better than that.

2. Elimination of the legal problems criterion is a step forward that helps us stabilize estimates across different policy regimes. A good step.

3. But retention of the socially maladaptive criteria fails to remove variation due to individual or socially shared responses. If your mother is of Islam, your alcohol  use will prompt a family problem. If Ethical Culture Society member, not so much. The distinction between the axis of social maladaptation deserves to be studied separately, and not made a defining criterion for our case definition.

4. Case definition can be framed as (a) presence of a disturbance of the mental life (such as obsession-like craving or rumination), (b) disturbance of behavior (such as compulsion-like repetitive use when such use is not wholly controlled by the user, and inserts itself into the behavioral repertoire even though the plan did not include that behavior), and (c) signs of neuroadaptive changes secondary to repetitive drug use (such as subjectively felt or lab-confirmed tolerance, or withdrawal signs or symptoms).

5. The term is “drug.” The term “substance is not a scientific term. It is a political term, introduced in the early 1979s when the US government had ambivalence about calling alcohol a drug. Use the term substance when you feel a need to be politically corr t, but in science, these all are drugs.

6. In American usage ‘illicit’ carries a moral overtone, as in an ‘illicit affair between Trump and Stormy Daniels’ — i.e., inherently pejorative Nd stigma-laden. Why use that adjective unless you wish to heap stigma upon users?

7. Is adult cannabis use ‘illegal’or ‘illicit’? Not in parts of the world like Portugal or Colorado or Washington State or California, etc. It is an “internationally regulated drug (IRD) under the psychotropic drug conventions, but it is neither illicit nor illegal in many parts of the world.

Choose your case definitions and terms wisely, and in a manner that promotes the public health goals you seek to achieve.

If you want to encourage people to seek treatment, don’t use stigma-lad n terms in your science and public health reports or work.

My two cents.

We often need images to show mechanisms.

Mechanisms images

Gross Anatomy of the Brain Tutorial

Limbic system tutorial

Not sure I believe the title, but an important article to read.

Once is too much.

Learn the opponent process model by studying it carefully.

Let’s discuss.

Epidemiology: worth a discussion

Epidemiology

Do you trust a NYT review on cannabis harms?

NYT article

My question: Compared to what?

Rural California and heroin

Rural California and heroin

Can this statistic be correct? Who will take responsibility?

Gabapentin in the news

Chicago Sun Times article.

Juuling

The Juul is a trendy vape pen that heats up liquid nicotine that users inhale. It has capsules or pods that come in a variety of flavors like "cool mint" and "fruit medley," each containing about as much nicotine as a pack of cigarettes. The flavorful pods are seemingly attractive to teen users.

"These flavors are drawing them in and the nicotine is forcing them to stay," Waxman said.

Juuling