The War on Drugs

[G M]

https://www.pingthread.com/thread/1654138816394035210

[ccp]

had one chronic user state he was beginning to notice hallucinations

I think he was in late 20 s or early 30s

had a few hyperemesis syndrome callers as well

seems to be in those who imbibe daily for prolonged period

but think of the revenue it brings in ....
like gambling ....

great for the big spenders in the bureaucracy
 

next we should tax sex .....

[G M]

The THC level in current MJ is off the charts when compared to what the Boomers kind of remember...

had one chronic user state he was beginning to notice hallucinations

I think he was in late 20 s or early 30s

had a few hyperemesis syndrome callers as well

seems to be in those who imbibe daily for prolonged period

but think of the revenue it brings in ....
like gambling ....

great for the big spenders in the bureaucracy
 

next we should tax sex .....

[Crafty_Dog]

" when compared to what the Boomers kind of remember..."

 

[Crafty_Dog]

https://www.nationalreview.com/news/oregonians-turning-against-mistake-drug-decriminalization-amid-record-ods-dystopian-nightmare/?bypass_key=bFQ1WXVXVXF5OVRYK3hONks0TFdLQT09OjpVMEl6T0hoRFZFRkxVazgyVlVka1REbHBaelJyZHowOQ%3D%3D?utm_source%3Demail&utm_medium=breaking&utm_campaign=newstrack&utm_term=32402130&utm_source=Sailthru

[Crafty_Dog]

https://geopoliticalfutures.com/trends-in-global-drug-use-and-production/?tpa=YmNmODA5NDc0NjEzN2Q0ZGJjNGFkZTE2OTU5MTU3NDE2MDExYTk&utm_source=newsletter&utm_medium=email&utm_term=https://geopoliticalfutures.com/trends-in-global-drug-use-and-production/?tpa=YmNmODA5NDc0NjEzN2Q0ZGJjNGFkZTE2OTU5MTU3NDE2MDExYTk&utm_content&utm_campaign=PAID%20-%20Everything%20as%20its%20published

[DougMacG]

Amazing story BBG (another thread).

In MN, we went from illegal to legal, all past offenses expunged, to SUBSIDIZED, in 3 months.

https://m.startribune.com/cannabis-manufacturing-facility-planned-for-former-timber-mill-in-grand-rapids-400-jobs-67-million/600312888/

I was satisfied with decriminalization.

[Body-by-Guinness]

I’m not quite sure how to take this. It may very well lower drug mortality in the US, but doesn’t do much to address any underlying incentive, and the cartel will sell something in its place while some other cartel will certainly fill any vacuum created:

https://legalinsurrection.com/2023/10/mexicos-largest-cartel-orders-ban-on-fentanyl-trafficking/?utm_source=rss&utm_medium=rss&utm_campaign=mexicos-largest-cartel-orders-ban-on-fentanyl-trafficking

[Crafty_Dog]

https://www.talkingdrugs.org/review-how-to-regulate-psychedelics-a-practical-guide/

[ccp]

I just did a medical review online course on psychedelics

some do have suggestions of value
but the evidence if VERY lacking on their effectiveness and risk
much beyond anectodal reports

I would copy you on them but it is propriety so probably not legal or ethical to do so.

How can one even study the effectiveness

It is hard to do a control placebo group with group that gets drug
since obviously the controls would know they are not getting anything

what doses do we use
some may be effective at microdoses below cognitive effects but help things like depression anxiety etc.

a few studies have used benadryl for the control group but people can tell the difference

then some study participants may be biased due to their expectations

most magic mushrooms

PSILOCYBIN  ("magic mushrooms")

and

MESCALINE (peyote) ( a cactus)

I always thought they were the same 

have variable active ingredients depending:
 For most plants, the time of year that harvesting occurs, as well as the methods used to harvest and process the plant, can also significantly alter chemical composition.

As a result even anectodal reports are unclear since the actual dose would be unknown.

The review was not against there use only that we don't really have a handle on them.

Reported side effects for example:

"The use of nonstandardized psilocybin mushrooms has been associated with multiple cases of toxicity. For example, seizures, myocardial infarction, and acute kidney failure have been reported in some patients [11,87,88].

There is also a growing body of literature on the adverse effects of purified psilocybin. Most clinical research agrees that the most common side effects noted at therapeutic doses are headache, nausea, anxiety, and transient elevations in blood pressure and heart rate."

"the most commonly reported adverse effects with peyote are nausea, vomiting, and diarrhea. These effects typically occur within 30 to 60 minutes of ingestion. It has also been reported to cause mydriasis, sweating, tremor, and elevations in blood pressure and heart rate within one hour after ingestion [95,96].

The hallucinations that occur with peyote have also been associated with anxiety, paranoia, fear, and emotional instability that has the potential to lead to self-inflicted or accidental injury [95,97,98].

Mescaline, the major active constituent of peyote, has been reported to cause respiratory depression when used in large doses (20 mg/kg or more) and, rarely, death. Most symptoms seen with mescaline subside within 24 hours of use

[Crafty_Dog]

I am told that in the tropics psilocybin mushrooms can be found in cow turds the morning after it rained at night.

[Crafty_Dog]

https://washingtontimes-dc.newsmemory.com/?token=fa0b1df5a98444eee5677945f4b93f7e_659577e1_6d25b5f&selDate=20240103

[Crafty_Dog]

HEALTH
PHARMA
HEARD ON THE STREET
Psychedelics Are Going Mainstream. Investing in Them Hasn’t.
Drugs like LSD have shown potential for treating psychiatric disorders. Wall Street and big pharma aren’t convinced.

Startups and big pharmaceutical companies are exploring medical uses of psychedelics like LSD, MDMA and psilocybin, the psychoactive compound in ‘magic mushrooms’ like the ones shown. KEVIN MOHATT FOR THE WALL STREET JOURNAL
By
David Wainer
Follow
Jan. 5, 2024 10:00 pm ET


Share

Resize
14

Listen

(3 min)


Psychedelics spent a half-century in political and medical purgatory. Now they’re starting to go mainstream. Respected academic institutes and billionaires are funding research into their therapeutic benefits, and the Food and Drug Administration could soon approve MDMA (known more commonly as ecstasy) for a treatment for post-traumatic stress disorder.

The therapeutic potential of these drugs looks promising, but Wall Street and big pharma are still not convinced of the financial potential. Intellectual property is one big concern. While new compounds discovered in a lab can often lead to over a decade of exclusive profits for a pharma company, psychedelics like LSD and psilocybin, the psychoactive compound in “magic mushrooms,” have been around for a long time. This makes patenting them more controversial. Companies are patenting formulations of the drugs and even things like the cozy furniture in a treatment room, but questions about patent protection abound.

Then there are the trips, which can take patients on whirlwind journeys through the recesses of their minds, lasting six to eight hours. From a therapeutic perspective, the altered perceptions might be the whole point: The trips have shown the potential to rewire the brain in a process known as neuroplasticity. (There are also companies developing tweaked versions of those drugs that reduce the highs while hoping to still provide therapeutic benefits.) But from a financial perspective, the inconsistency of psychedelic experiences and the fact that they require hands-on psychological therapy make for a difficult investment pitch. Treatment is typically administered in a specialized facility under supervision by psychiatric professionals, which is costlier and harder to scale up than simply providing medicine.

“It’s not the same as going to your pharmacy and picking up a pill bottle,” says Brian Abrahams, an analyst at RBC Capital Markets.

The industry’s market performance reflects such fears, which are magnified at a time when higher rates make riskier stocks harder to own. While many psychedelic companies listed in the stock market with much fanfare in recent years and surged  as the biotech bubble peaked around 2021, the industry has nosedived more recently.  The AdvisorShares Psychedelics ETF is down over 80% since its 2021 inception. Shares in Atai Life Sciences, a prominent startup backed by billionaire Peter Thiel, are down over 90% since going public at a $3 billion valuation.

True, the entire biotech industry has been negatively affected by higher rates. But there is still plenty of investor appetite for high-quality biotech companies, many of which are getting snapped up by big pharma at massive premiums these days. That is especially the case in the psychiatric realm, where available treatments are far from ideal and many patients are stuck with no helpful options. Yet save for Otsuka Pharmaceutical’s $59 million acquisition last year of Mindset Pharma, the industry has steered clear of psychedelics.

While big pharma dollars may not be pouring in yet, the industry has still been able to raise money in recent months through a flurry of financing including a $100 million stock sale by the Multidisciplinary Association for Psychedelic Studies, a nonprofit leader.

MAPS Public Benefit Corp., which has raised money from billionaires like New York Mets owner Steven Cohen, last month filed an application with the FDA for approval of MDMA in combination with talk therapy to reduce the symptoms of post-traumatic stress disorder. The fact that the first possible approval for MDMA could go to a nonprofit underscores how it’s been idealism, and not just profits, pushing the industry forward.

The questions swirling around the economics of psychedelics don’t mean there won’t be money to be made, or that this isn’t a therapeutic area worth investigating. Many of the biggest proponents of such drugs, in fact, are very worried about corporations profiting from the “gifts of nature.” Serious researchers are also concerned about potential blowback if things move too quickly. “Many people forget that there were years of glowing reviews in the 1950s and 1960s before the press turned alarmist and a government clampdown prevented research progress for decades,”  David Yaden, a professor in psychedelic research at Johns Hopkins University, wrote with two other colleagues.

For businesses that can navigate the FDA hurdles, medical reimbursement coding and intellectual-property fights, there could yet be a significant market. The path is being paved by big pharma. Johnson & Johnson’s Spravato, a chemically related version of ketamine that was approved by the FDA in 2019 for treatment-resistant depression, is carving out a new business model. Sales of Spravato, which must be administered in a treatment center, are expected to climb to about $1 billion this year, according to analysts polled by Visible Alpha. (Matthew Perry’s recent death from acute effects of ketamine sparked controversy around the anesthetic, though the concentration in his system suggested that he had taken it at home without supervision.)


Compass Pathways is seeking to be the first to receive FDA approval for a synthetic formulation of psilocybin. PHOTO: KEVIN MOHATT FOR THE WALL STREET JOURNAL
Ketamine can produce out-of-body, hallucinogenic sensations, but it is nothing like magic mushrooms or LSD. For one, side effects tend to peak at 40 minutes, versus hours for other psychedelics. Yet its growing use sets a precedent, says Thomas Shrader, an analyst at BTIG. If the number of sites administering Spravato continue to grow, they will help expand the new world of “interventional psychiatry,” he said.

Compass Pathways has the largest market capitalization among psychedelic companies and is seeking to be the first to receive FDA approval for a synthetic formulation of psilocybin, the psychoactive compound in magic mushrooms. The company is currently conducting a late-stage study that is likely to wrap up next year. If successful, it could lead to FDA approval sometime in 2026, according to Chief Executive Kabir Nath, who has held leadership positions at pharma companies like Otsuka and Bristol-Myers Squibb. If Compass’s drug receives FDA approval, Nath sees a similar trajectory to J&J’s Spravato, which is holding up well despite competition from ketamine clinics.

Psychedelics won’t bring world peace and they probably won’t be huge blockbusters either. But in the difficult field of treatment for mental illness, their revival could be a helpful advance for some patients, and some long-patient innovators

[Body-by-Guinness]

Posted primarily as I’ve seen sundry “weed causes psychosis” pieces tither and yon of late:

https://www.cato.org/blog/wall-street-journal-columnist-triggers-reefer-madness-flashback

[Body-by-Guinness]

Review of book about the rise of women in Latin America:

SWJ EL CENTRO BOOK REVIEW – NARCAS: THE SECRET RISE OF WOMEN IN LATIN AMERICA’S CARTELS

Articles
Tue, 02/06/2024 - 4:03pm
SWJ El Centro Book Review – Narcas: The Secret Rise of Women in Latin America’s Cartels

Nathan P. Jones

Narcas
Deborah Bonello, Narcas: The Secret Rise of Women in Latin America’s Cartels. Boston: Beacon Press, 2023 [ISBN-13:‎ 978-0807007044, Hardback; 166 pages]

Deborah Bonello’s Narcas: the Secret Rise of Women in Latin America’s Cartels brings to light the role of women in the drug trafficking industry; an often-overlooked phenomenon. Deborah Bonello masterfully provides a window into the lives of the women who have become major drug traffickers and, more often, minor players (p. 90). Through interviews, archival research, and the meticulous review of court documents, Bonello provides important empirical case studies with journalistic flair, bringing nuance to an understudied issue.

Informants

Bonello makes important points that are valuable broadly to the study of drug trafficking. One point she highlights in the context of one of the women she profiles, is the need to protect informants. In one case one of the women she profiled had both of her sons murdered while she was meeting with Colombian authorities and US DEA. The subject attributed those meetings in which she continued to be incarcerated in Colombia as leading to the murder of her sons (p. 128). Thus, she ultimately did not cooperate so that other family members would not be killed. The lesson that she learned was that any cooperation could result in the death of her family as her lawyer argued on her behalf (p. 131). This is an important issue related to informants impacting both men and women in the organized crime world.

Las Buchonas

The concept of buchonas has in recent years drawn increased attention in the study of Mexican drug trafficking (pp. 107–115). Buchonas are the attractive girlfriends and wives of drug traffickers (or traffickers themselves). This lifestyle which focuses on a very specific aesthetic has drawn significant attention and impacted the lives of women participating in and in the orbit of drug trafficking in Mexico and beyond. Here Bonello elucidates how women can become both victims and victimizers/active participants with their own agency in the world of Mexican drug trafficking.  Bonello brings to this discussion a self-reflective view of the women who participated in these extensive surgeries in pursuit of an aesthetic which increasingly supports a broader narcocultura promoted and diffused by narcas like Emma Coronel, the wife of extradited Chapo Guzmán, former head of the Sinaloa Cartel.

Women and MS-13

Nowhere is the issue of women as victims versus participants more acute than in the case of women and their role in MS-13. Bonello describes the girlfriends of MS-13 members visiting their boyfriends in Central American prisons; the power and agency their relationships entail, but also the victimization those relationships imply from the police, MS-13, and society more broadly. It would be interesting to see these discussions updated as the security crackdown of President Bukele, who was reelected (Feb 2024) plays out. All analysts of the region are carefully watching the security gains accompanied by likely human rights violations. Bonello further discusses the role of women as MS-13 members themselves and the various policy changes the MS13 leadership in Central America has implemented related to the membership of women.

A Powerful Read

Narcas is an excellent look into the role of women in Latin American drug trafficking which includes case studies spanning Guatemala, Colombia, Honduras, El Salvador, Mexico, and the United States. It would be excellent for any course in criminology looking at Latin America, a political science course on drug trafficking or security issues, or various sociology courses at the graduate and undergraduate levels. It is a fast and enjoyable read built upon the research of an intrepid reporter for Vice News; an outlet which has been impressive on Latin American security reporting. Bonello is particularly good at getting access to high level female traffickers and then drawing the general from the specific.

There are few places where I can suggest any improvement to this book. I hoped to read on the role of women like Rosalinda González Valencia, the wife of El Mencho the leader of the Cártel de Jalisco Nueva Generación (CJNG). She came from the Valencia family, which was important in the Milenio cartel, a precursor to the CJNG. She has been identified by numerous publications such as El País as critical to the money laundering operations of the CJNG and is an example of a woman in drug trafficking meriting further study. This is not a critique of the book, rather an acknowledgement that we can always cover more and that the inherently difficult to study drug world will always leave us waiting for the revelations of case studies such as this.

Conclusion

Deborah Bonello’s fine work on the role of women in Latin American drug trafficking gives us a richer more nuanced view of the role they play. This view demonstrates women may have far more agency and capacity to use nonviolent mechanisms to move to the top of the drug trafficking world than we realize. One of her key points is that women are more able to remain invisible in the face of state action and rival cartels. This is a critical point for anyone studying the sociology of drug trafficking and women’s ability to survive and thrive in an increasingly globalized world where borders are easily penetrated by illicit flows.

Categories: SWJ Book Review - Mexico - drug cartels

https://smallwarsjournal.com/jrnl/art/swj-el-centro-book-review-narcas-secret-rise-women-latin-americas-cartels

[Body-by-Guinness]

Piece argues increase in OD deaths not cause by legalization, but oh well:

Did the Fentanyl Wave Hit Oregon Just as Voters Decriminalized Drugs?

Cato @ Liberty by Jeffrey A. Singer / Feb 6, 2024 at 3:09 PM

Jeffrey A. Singer

Three years after its first‐​in‐​the‐​nation drug decriminalization measure (Measure 110) went into effect, Oregon’s lawmakers are poised to re‐​criminalize possessing and using drugs. Lawmakers note that Oregon’s overdose rate has risen dramatically and exceeded the national average since Measure 110 took effect in 2021.

I have argued here that policymakers were mistaken if they believed decriminalizing drugs would necessarily lead to a drop in overdoses. Decriminalizing is not the same as legalizing. As long as people who use drugs need to go to the black market for them, they can never be sure of the dose or purity of what they are buying or if it is the drug they think they are buying. I also argued that it is inappropriate to judge Measure 110 so soon after the law went into effect. For example, in its first year, the country was amid the COVID-19 pandemic, and public health measures made it even more challenging than usual for Oregonians to access harm reduction and treatment programs.

However, writing in the New York Times this week, addiction and neuroscience journalist Maia Szalavitz contends that, while people may be quick to assume that the rise in overdoses during Measure 110’s implementation suggests cause and effect, it is essential to remember that correlation is not causation. Szalavitz provides crucial information placing Oregon’s overdose problem in proper context.

Szalavitz points to numerous studies showing that illicit fentanyl flooded the drug market in waves, beginning in the eastern US and working its way west. Szalavitz cites work by Brandon del Pozo of Brown University Medical School, showing nearly identical surges in overdose rates in every region of the country as fentanyl began dominating the drug market. Szalavitz cites research showing that almost 90 percent of overdose deaths involving fentanyl and its analogs occurred in 28 states east of the Mississippi River. Additional research published in 2023 showed a similar wave making its way across the country, finally dominating western states, including Oregon, around 2021.

Investigators at Brown University Medical School and the Research Triangle Institute (RTI International) used Centers for Disease Control and Prevention overdose mortality data from 2008–2022 and a synthetic control group consisting of 48 states and the District of Columbia to study the association between overdose fatality rates and Measure 110. They used a changepoint analysis to determine “when each state experienced a rapid escalation in fentanyl.” The researchers concluded:

After adjusting for the rapid escalation in of fentanyl, analysis found no association between M110 and fatal drug overdose rates.

Future evaluations of the health effects of drug policies should account for changes in the composition of unregulated drug markets.

The researchers also found:

Recriminalization in Washington State saw an increase in the fatal overdose rate.

Before lawmakers return to tactics that have proven to be a dismal failure for more than 50 years and risk exacerbating Oregon’s drug overdose problem, they should listen to drug policy researchers who point out that Oregon’s surge in overdose deaths corresponds to the late arrival of fentanyl in the state relative to other parts of the US.

If lawmakers want to know where to place the blame for Oregon’s overdose crisis, the answer should be obvious: prohibition.

[Crafty_Dog]

I wonder if data would be different with edibles. 
===========
Even 1 Joint per Week Enough to Boost Heart Disease Risk: Study
New large-scale research presents some of the most damning evidence yet about marijuana’s impact on cardiovascular health.
Even 1 Joint per Week Enough to Boost Heart Disease Risk: Study
(Vuk Stajic/Shutterstock)
By George Citroner
3/21/2024



Lighting up a joint once or more a week? That puff of marijuana could be seriously hurting your heart.

A new study finds that even relatively infrequent cannabis use is linked to higher risks of having a heart attack or stroke—and the more you smoke, the more danger you’re in.

The large-scale research presents some of the most damning evidence yet about marijuana’s impact on cardiovascular health.
Marijuana Smoking as Risky as Tobacco for Heart Health

Using cannabis is associated with an increased risk of cardiovascular diseases, even among nontobacco smokers, according to a new study published in the Journal of the American Heart Association. Previous research had linked marijuana use to heart disease risk, but those findings were often dismissed because many participants also smoked tobacco, which has long been linked to various cardiovascular issues.

In the new study, researchers analyzed data from over 434,000 patients aged 18 to 74, collected between 2016 and 2020 from the U.S. Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance Survey.

About 75 percent of the study participants said smoking was the most common way they consumed marijuana, but they also reported using edibles and vaping. However, the researchers did not specifically compare the risks of smoking marijuana versus consuming edibles.

25 Percent Higher Heart Attack Risk, 42 Percent Greater Stroke Risk

The study found that compared to those who never used marijuana, daily cannabis smokers had a 25 percent increased likelihood of heart attack and a 42 percent greater risk of experiencing strokes.

Among adults at risk for premature cardiovascular disease (defined as men under 55 and women under 65), cannabis use was significantly associated with nearly 40 percent higher combined odds of coronary heart disease, heart attack, and stroke, regardless of whether they used traditional tobacco products or not.

The researchers conducted a separate analysis of a smaller subgroup of adults who never smoked tobacco or used nicotine e-cigarettes and still found a significant association between cannabis use and an increased combined risk of developing coronary heart disease, including heart attack and stroke.

“Cannabis smoke is not all that different from tobacco smoke, except for the psychoactive drug: THC vs. nicotine,” Abra Jeffers, a data analyst at Massachusetts General Hospital in Boston and lead study author, said in a press statement.

The study shows smoking cannabis has significant cardiovascular risks, just like smoking tobacco, she noted. “This is particularly important because cannabis use is increasing, and conventional tobacco use is decreasing.”

Notably, participants who reported using marijuana only once per week still showed about a 3 percent increased likelihood of having a heart attack or stroke during the study period. However, the study was not designed to establish whether marijuana use directly caused this increase in risk.

Legal Weed Fueling Rise in Cannabis Use Across US, Data Reveal

While marijuana remains illegal at the federal level, 24 states and Washington, D.C., have legalized recreational cannabis possession and use so far.

A 2019 National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration (SAMHSA) found more than 48 million people aged 12 or older reported using cannabis at least once, compared to only 25.8 million people in that age range in 2002—an increase from 11 percent to 17 percent. There is also evidence that this trend toward legalization has led to growing numbers of people living with addiction.

Recent data show a significant increase in cannabis usage. In 2007, approximately 10 percent of people used cannabis, but by 2022, that figure had more than doubled to 22 percent, according to SAMHSA.

The rise in cannabis consumption has also prompted concerns about the potential for marijuana use disorder. One study estimates that about one in three cannabis users may develop this disorder. Another study found that the risk is even greater for those who start using marijuana during their youth or adolescence and for those who use it more frequently.

Regardless of whether more states legalize cannabis, there is a need for more regulation of the forms, content, and marketing of cannabis products to consumers, Ms. Jeffers told The Epoch Times.

“Like tobacco, it should be legal but discouraged,” she said. “Furthermore, more guidance to physicians on screening and counseling for cannabis use is necessary.”

Marijuana Legalization Is Putting People at Risk: Doctor

The research contributes to the growing evidence linking cannabis use with increased cardiovascular-related deaths and highlights the inherent dangers of legalizing it, Dr. Christopher Varughese, an Interventional and General Cardiology physician at Staten Island University Hospital, not associated with the study, told The Epoch Times.

“They found an increased risk of coronary heart disease, myocardial infarction (heart attack), and stroke,” he said. “Legalization of cannabis may place the public at greater risk for future cardiovascular events.”

While the observational study couldn’t prove marijuana caused the increased cardiovascular disease risk, the findings suggest cannabis use should be held to the same standards as tobacco regarding health risks, Dr. Varughese noted, emphasizing the need for strong public awareness efforts on the potential future cardiovascular risks.

As more data emerge, there is a clear association between cannabis use and future cardiovascular events, Dr. Varughese said. The risk increases with more frequent use, independent of tobacco.

“Most importantly, the increased risk was also observed in younger individuals, highlighting the potential concerns for this population segment,” he said.

[DougMacG]

"I wonder if data would be different with edibles."

I don't know the answer to this and I haven't seen that it has been studied well. But THC elevates blood pressure and heart rate, so edibles definitely have some effect without inhaling smoke. Also very easy to ingest more than the intended amount with edibles.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461323/#:~:text=THC%20causes%20an%20acute%2C%20dose,and%20heart%20rate%20(HR).&text=Due%20to%20a%20quickly%20developing,usage%20frequency%20are%20commonly%20observed.
===========
"Even 1 Joint per Week Enough to Boost Heart Disease Risk"

What a strange metric, even one joint a week. According to the internet, one joint can equal 35 or more hits, where two or three small puffs ought to be enough for a casual user get the effect. At least that's what I hear the other kids say.
https://leafnation.com/cannabis/how-much-thc-is-in-a-joint/#How_Many_Hits_Do_You_Get_In_a_Joint

A casual user would not sit down once a week and have 20 times the needed dosage, IMHO, at least not intentionally.

[Body-by-Guinness]

This mirrors my experience while contending with cancer and lesser boo boos:

The War on Drugs Is Also a War on Pain Patients

Cato @ Liberty / by Jeffrey A. Singer / Apr 1, 2024 at 10:37 AM

Jeffrey A. Singer

Doctor's Exam with Prescription
In a March 22 opinion column in the New York Times entitled “The DEA Needs to Stay Out of Medicine,” Vanderbilt University Medical Center associate professor of anesthesiology and pain management Shravani Durbhakula, MD, documents powerfully how patients suffering from severe pain—many of them terminal cancer patients—have become collateral casualties in the government’s war on drugs.

Decrying the Drug Enforcement Administration’s progressive tightening of opioid manufacturing quotas, Dr. Durbhakula writes:

In theory, fewer opioids sold means fewer inappropriate scripts filled, which should curb the diversion of prescription opioids for illicit purposes and decrease overdose deaths — right?

I can tell you from the front lines that that’s not quite right. Prescription opioids once drove the opioid crisis. But in recent years opioid prescriptions have significantly fallen, while overdose deaths have been at a record high. America’s new wave of fatalities is largely a result of the illicit market, specifically illicit fentanyl. And as production cuts contribute to the reduction of the already strained supply of legal, regulated prescription opioids, drug shortages stand to affect the more than 50 million people suffering from chronic pain in more ways than at the pharmacy counter.

Dr. Durbhakula provides stories of patients having to travel long distances to see their doctors in person due to DEA requirements about opioid prescriptions. However, despite their efforts, they find that many of the pharmacies do not have the opioids they require because of quotas. She writes:

Health care professionals and pharmacies in this country are chained by the Drug Enforcement Administration. Our patients’ stress is the result not of an orchestrated set of practice guidelines or a comprehensive clinical policy but rather of one government agency’s crude, broad‐​stroke technique to mitigate a public health crisis through manufacturing limits — the gradual and repeated rationing of how much opioids can be produced by legitimate entities.

In the essay, Dr.Durbhakula does not question or challenge the false narrative that the overdose crisis originated with doctors “overprescribing” opioids to their pain patients.

Unfortunately, Dr. Durbhakula’s proposed policy recommendations would do little to advance patient and physician autonomy. She would merely transfer control over doctors treating pain from the cops to federal health bureaucracies and let those agencies set opioid production quotas. For instance, she claims, “It’s incumbent on us [doctors] to hand the reins of authority over to public health institutions better suited to the task.”

No. The “reins of authority” belong in the hands of patients and doctors.

Dr. Durbhakula suggests that “instead of defining medical aptness, the DEA should pass the baton to our nation’s public health agencies” and proposes that the Centers for Disease Control and Prevention and the Food and Drug Administration “collaborate” to “place controls on individual prescribing and respond to inappropriate prescribing.” She elides the fact that these public health agencies will “respond” to doctors or patients who don’t comply with their regulations by calling the cops.

To be sure, Dr. Durbhakula has good intentions. But replacing actual cops—the DEA—with federal health agencies that can order those cops to arrest non‐​compliant doctors and patients is like rearranging the deck chairs on the Titanic. True, her proposed new pain management overlords would have greater medical expertise, but they would still reign over doctors and patients and assault their autonomy. And, as we learned during the COVID-19 pandemic, they will not be immune to political pressures and groupthink.

While her policy prescriptions may be flawed, Dr. Durbhakula deserves praise for having the courage to point out that the war on drugs is also a war on pain patients. Alas, courageous doctors are in short supply these days. Most doctors keep their heads down and follow the cops’ instructions.

After I read her essay, I wrote the following (unpublished) letter to the editor of the New York Times:

Dear Editor—

Kudos to Dr. Durhakula for speaking out against the Drug Enforcement Administration’s intruding on doctors’ pain treatment (“The DEA Needs to Stay Out of Medicine,” March 22, 2024). As my colleague and I explained in our 2022 Cato Institute white paper, “Cops Practicing Medicine,” for more than 100 years, law enforcement has been increasingly surveilling and regulating pain management.

The DEA maintains a schedule of substances it controls, and it categorizes them based on what the agency determines to be their safety and addictive potential. The DEA even presumes to know how many and what kind of controlled substances—from stimulants like Adderall to narcotics like oxycodone—the entire US population will need in future years, setting quotas on how many each pharmaceutical manufacturer may annually produce.

The DEA restricts pain management based on the flawed assumption that what they consider to be “overtreatment” caused the overdose crisis. However, as my colleagues and I showed, there is no correlation between the opioid prescription rate and the rate of non‐​medical opioid use or opioid addiction. And, of course, as fear of DEA reprisal has caused the prescription rate to drop precipitously in the last dozen years, overdose deaths have soared as the black market provided non‐​medical users of “diverted” prescription pain pills first with more dangerous heroin and later with fentanyl.

Researchers at the University of Pittsburgh School of Public Health found that overdose fatalities have been rising exponentially since at least the late 1970s, with different drugs predominating during various periods. Complex sociocultural, psychosocial, and socioeconomic forces are at the root of the overdose crisis, requiring serious investigation. Yet policymakers have chosen the lazy answer by blaming the overdose crisis on doctors treating pain.

When cops practice medicine, overdoses increase, drug cartels get richer, and patients suffer.

Sincerely,

Jeffrey A. Singer, MD, FACS

Senior Fellow, Cato Institute

When cops practice medicine, overdoses increase, drug cartels get richer, and patients suffer.

https://www.cato.org/blog/war-drugs-also-war-pain-patients