Mentally ill, addicted and tobacco: Public views change slowly as clinicians start taking responsibility for smoking cessation

Posted on September 14, 2011 by

The new frontier in the war against tobacco is special populations, particularly people with

Outdated views on smoking among the mentally ill and addicted need to be changed.

mental disorders, including addiction. Unfortunately, an uninformed, paternalistic public view prevails about smokers with schizophrenia or alcoholism, and it goes like this: “Oh, those poor people. Why don’t you just leave them alone and let them smoke? God knows they’ve got enough problems.”

That presumes, at best, that people with behavioral conditions don’t want to quit smoking or, at worst, that their lives aren’t worth saving. Fortunately, this blindness to the problem of smoking among people with mental illnesses is beginning to clear as reality dawns:

Smoking rate in the general US population is about 20%, although it's as low as 12% in California

• People with psychiatric diagnoses have much higher rates of smoking and smoke more cigarettes than the general populations. In the United States, 44% of cigarettes are consumed by people with mental illnesses, including substance use disorders. People with serious mental illnesses die on average 25 years earlier than the general population, usually from tobacco-related disorders such as heart and lung disease.

• Alcoholics are three times more likely to smoke than the general population.  Alcoholics are more likely to die from tobacco than from alcohol.

In the past, psychiatrists, drug treatment counselors and other clinicians believed that patient smoking wasn’t their problem. Many still believe that. But a growing number are changing their minds. Drug counselors – many of whom are themselves recovering addicts who smoke – are facing up to the findings that quitting smoking during treatment doesn’t harm recovery and, in fact, may help it. A belief-change is growing among psychiatrists and other clinicians in behavioral health that confronting smoking among patients is part of their job. An editorial in the September 2011 edition of the American Journal of Psychiatry concluded that when a psychiatrist is faced with a patient who smokes, “doing nothing is now unacceptable.”

The editorial categorically rejects those unthinking assumptions that have cost the lives of countless people with mental illnesses:

• “These patients do not want to quit.” In fact, they do, and at rates (70%–80%) comparable to those in the general population.

• “They are not able to quit.” But many do, and with only slightly less success than the general population.

• “If they quit, their mental health or substance abuse conditions will worsen.” Mental health conditions can be stable or even improve, alcoholics who stop smoking are more likely to stay sober, and hospital wards that go smoke-free have fewer aggressive incidents and more staff time freed up for therapeutic encounters.

Excellent support exists for clinicians who want to help patients quit smoking: http://smokingcessationleadership.ucsf.edu/BehavioralHealth.htm

The Smoking Cessation Leadership Center at University of California San Francisco launched a comprehensive effort to train and support behavioral health clinicians in how to help patients quit smoking, including through a good series of newsletters that anybody can subscribe to. Clinicians who are tired of watching their behavioral health patients kill themselves with cigarettes should check it out.

Posted in Tobacco, Big Tobacco, Smoking, Tobacco cessation | Tagged , , , , , , , , , , , , , , , , , , , , , | 1 Comment

After legalization, the powerful marijuana lobby would kill marijuana taxes. Just ask the San Diego City Council…

Posted on June 21, 2011 by

Would NORML fight for high taxes against the rest of the MJ lobby? Not very likely...

Advocates for legal marijuana promise that we could tax the heck out of it to pay for any costs it might create, such as the costs of treating the increased number of people addicted to marijuana.

But something happened in San Diego that should make you wonder about such claims. The City of San Diego recently voted for minor regulations on medical marijuana dispensaries to limit them to commercial and industrial zones and keep them at least 600 feet from schools, playgrounds, libraries, child care facilities, parks and churches. Sounds reasonable, right?

Not to the pro-marijuana folks. They quickly got up 46,000 signatures to reverse the regulations and put them on the ballot instead. Citizens for Patient Rights, the Patient Care Association of California and the California Cannabis Coalition raised nearly $150,000 to hire a professional signature-gathering firm. But the City Council says it probably won’t spend the necessary $3 million for an election over these restrictions, not when the city is practically bankrupt. So instead, restrictions on medical marijuana dispensaries will likely be rescinded.

Moneyed special interests always have their own way in California, and marijuana already is a moneyed special interest. It will become an extremely wealthy and powerful industry if marijuana is legalized. Marijuana taxes would be killed by the marijuana industry, just like alcohol and tobacco taxes have always been killed by the powerful alcohol and tobacco industries. Marijuana legalization advocates promise they will support high taxes on marijuana. But San Diego couldn’t even restrict pot dispensaries from opening up near schools without a deadly backlash from the marijuana lobby. What chance would marijuana taxes have?

Posted in Addiction, Marijuana, Marijuana legalization, Medical marijuana, MJ lobby, Recovery, Substance abuse | Tagged , , , , , , , , , , , , , , | 5 Comments

Ignition interlock for all DUIs: A idea whose time has come

Posted on May 28, 2011 by

We know how to prevent drunk driving crashes, we just don't do it...

Ignition interlock is an affront to many Americans for who believe that their car is an extension of their individual rights. Adding a device that stops people from driving whenever they want to seems downright sacrilegious. The truth, of course, is that driving a car isn’t a right at all but a privilege that can be taken away whenever the state deems necessary. The state of Kansas just took another step toward demanding responsibility of its drivers by mandating ignition interlock for all DUI offenders, including first-timers.

Ignition interlock is a tube that you breathe through before you can start your car. If you’ve been drinking, you can’t start your car. And then, at random times when you are driving, the device demands you breathe through the tube again. If you don’t, or if you’ve started drinking after you started your car, the flashers and car alarms go on until you pull over and stop the car. Research has shown conclusively that ignition interlock works very well to reduce DUI.

Ignition interlock is a simple concept that can save lives, including hers

But many states and many judges are reluctant to use ignition interlock as a deterrence, instead only seeing it as a punishment for chronic offenders who have been caught driving drunk several times or have very high blood alcohol content. This never made any sense to me. Shouldn’t we try to prevent people from driving drunk, the most common violent crime in America, rather than just punishing them after they do it?

Recent research in New Mexico shows that first-time DUI offenders are five times more likely to get arrested for drunk driving within three years compared to people who have never been arrested for DUI. One major study by the National Highway Traffic Safety Administration shows that first-time DUI offenders who get interlock on their car have a 61 percent lower recidivism rate compared to non-interlock offenders. We can stop a lot of people from being repeat DUI offenders, and save lots of lives, by mandating ignition interlock for first-time DUI offenders, and leaving the device on their cars for many years.

First-timers are five times more likely to drive drunk again compared to people who have never been arrested for DUI.

People who don’t read research argue that drunk drivers who are intent on driving will just find another car to drive. If that were true, then research wouldn’t show that interlock works. The truth is that it’s not so easy to find another car to drive than the one you own. Some people could, but not many. How often do any of us drive cars that are not ours?

So far, about a dozen states use interlock for first-time DUI offenders. Mothers Against Drunk Driving (MADD) is pushing for all states to mandate the device for all first-time offenders (check out good FAQ here).

Really, there’s no good reason not to do this. The only thing stopping it is the phantom belief that driving a car is linked to sanctified personal freedoms. Many state legislatures and judges actually believe that.

Posted in Alcohol, Alcohol abuse, Binge drinking, Drunk driving, Recovery | Tagged , , , , , , , | Leave a comment

Some bad news from California: We’re not a smoke-free state

Posted on April 16, 2011 by

WRONG! South Dakota can make this claim, but not the Golden State

Not too long ago, I was bragging on California in this blog because we have one of the lowest smoking rates in the country, lower than some other states by half. I said that was because California had gone smoke-free nearly 20 years ago. But now I learn that isn’t true, that California isn’t officially smoke-free and never has been.

According to the US Centers for Disease Control, 24 states have enacted complete smoking bans in workplaces, restaurants and bars, and California isn’t one of them. The reason why is because the groundbreaking California Smoke-free Workplace Act, passed in 1994 and never updated, today has too many holes in it that leave too many people exposed to second-hand smoke.

Now, there’s legislation afoot that will once again allow California to lead the nation in anti-tobacco action (but more importantly will help protect workers and other people from secondhand smoke). Senate Bill 575by Sen. Mark DeSaulnier, D-Walnut Creek, is wending its way through the state legislative process this spring and summer; the bill will remove exemptions that allow indoor smoking in certain workplaces and restrict indoor tobacco smoking in owner-operated businesses. The latter is important because there’s a proliferation of hookah bars in California operating in a grey area of the law because they are supposedly owner-operated and have five or fewer employees. The new law would define owner-operated as businesses having no employees, independent contractors or

Hookah bars are very trendy in California right now. Young people believe that if you smoke tobacco through water, it's not so bad for you. Then again, some people still believe that cigarettes with filters are better for you. Closing the loopholes in California's law will mean the end of hookah bars.

volunteers – just the owner as the only worker. Under current law, it’s OK to threaten the health of your employees if you have only five or less of them. So, if this law passes, no more indoor hookah bars, popular with young people who falsely believe hookah smoking isn’t dangerous, and no more cigar lounges in tobacco stores.

This legislation is fiercely opposed by tobacco stores, and especially cigar stores, which have no shame about the fact that they’re selling a product that kills half the people who use it as directed. Also opposing the bill, strangely enough, is the California Association of Health Facilities, which represents long-term care providers. It argues that smoking is one of the last activities that some patients can enjoy, and so they should be allowed to do it inside care facilities. To me, this is a terribly paternalistic argument; sounds like they’re saying that these poor little people are going to die anyway, so why not let them smoke? It ignores that everybody in long-term care will be physically harmed by breathing tobacco smoke, including all the workers. I’ve never understood the idea of allowing smoking in health facilities anyway.

California’s supposed smoke-free law still allows smoking, under certain conditions, in hotel lobbies, hotel and motel guest rooms, banquet facilities, small businesses, break rooms, owner-operated businesses, tobacco shops and private smokers’ lounges, warehouses, company vehicles, long-term health care facilities, volunteer-operated facilities, theatrical productions and medical research or treatment sites.  When California’s smoke-free law was passed, we didn’t know what we know today about the dangers of second-hand smoke. Since then, the US Surgeon General has stated unequivocally that separate smoking rooms and ventilation systems do not eliminate exposure to secondhand smoke, and there is no safe exposure to tobacco smoke. Now we know that secondhand smoke causes heart disease and lung cancer in nonsmoking adults and a number of health conditions, including sudden infant death syndrome and respiratory infections, in children. Smoke-free places not only protect us from secondhand smoke, but they also encourage smokers to quit.

Yet, Iowa, Maine, Kansas, South Dakota, Montana, even Arizona among other states have tougher smoke-free laws than California. Turkey, Bhutan and Uruguay have tougher smoke-free laws than California. When California became the first state to make bars and restaurants smoke-free, people said it would never work. Now, the rest of the world is starting to surpass the Golden State. California needs to show a little pride, pass SB 575 and become truly smoke-free.

Posted in Addiction, Big Tobacco, Cigarette warning labels, Recovery, Second-hand smoke, Smoke-free, Smoking, Substance abuse, Tobacco, Tobacco and kids | Tagged , , , , , , , , , , , , , | Leave a comment

Free will doesn’t work with addiction, and science shows why

Posted on April 9, 2011 by

A lot of people stigmatize addiction by talking about bad choices and free will. Folks in recovery and addiction treatment professionals have known for decades that free will can’t help an addict choose not to drink or drug, and now science shows why.

An excellent article published in 2009 in the journal Addiction entitled “The 10 most

Nucleus accumbens in a primative part of the brain kicks off the craving for drugs and alcohol. The first conscious thought comes later in the prefrontal cortex.

important things known about addiction” tells how the decision to take the first drink or drug is actually pre-conscious in the addict’s brain, and exists well before the idea pops into conscious thought. Doug Sellman, professor of psychiatry and addiction medicine at the National Addiction Centre in New Zealand, talks about how drug-seeking behavior is launched in the nucleus accumbens, located in an evolutionary primitive region of the brain. This is the pleasure center that kicks off the craving of a drug (and alcohol is a drug), lighting up with a surge of electrochemical activity. This decision-making center is in a pre-conscious part of the brain, in the same area where hunger and thirst come from. It cues the conscious parts of the brain in the prefrontal cortex to start thinking about how taking a drink or smoking some crack might be a good idea. Usually, an impulse from the pre-conscious part of the brain takes place a half-second before the conscious thought. But in the addict’s brain, the lag time between pre-conscious impulse and conscious thought can take longer when it comes to drugs, and the impulse can be a lot more powerful.  Sellman writes:

“…The usual disconnected human state of living consciously half a second behind what has already been ‘decided’ is exaggerated in people with addiction, because the initiation of drug-seeking behavior is engaging a well-worn pattern of learned compulsive behavior, overriding the ability to alter course when anticipated negative consequences are finally realized.”

In other words, an addict can have a ton of good intentions about not picking up the first drink or drug, but it won’t do any good. This same idea, by the way, was written in the book Alcoholics Anonymous in 1935. The alcoholic, it says, “will be absolutely unable to stop drinking on the basis of self-knowledge.” And in another place: “The alcoholic at certain times has no effective mental defense against the first drink.” Now we know why. The craving for a drink or a drug comes from a place deep down in the addict’s brain. By the time the addict starts consciously thinking about picking up a drink or drug, it may already be too late to stop it.

Posted in Addiction, Alcohol, Alcohol abuse, Drug abuse, Recovery, Tobacco | Tagged , , , , , , , , , | 1 Comment

Medical marijuana in the Wild West: Montana vs. New Mexico

Posted on March 8, 2011 by

One out of every 19 households in Montana has a medical marijuana card...and that number is growing. Sure are a lot of sick people in that state.

Montana may repeal its medical marijuana law. The Treasure State took a Wild West, anything goes approach to medical marijuana, much like Colorado and California, and people there are fairly shocked by what happened. Marijuana purveyors popped up all over the place with high-powered marketing and outreach, a statewide pot industry quickly grew up, and today there are more than 28,000 registered users in a state with less than 1 million people. And, a third of them are under 30, which is really silly because young people are generally very healthy and don’t much use medical services.

Here’s what a recent Associated Press article said happened in Montana:

Advocates and distributors figured out they could sign up thousands of people who claim to suffer from “chronic pain” — a vague term covering everything from creaky knees to sore backs to persistent headaches.

They started caravans, going from town to town to register patients by the thousands…

The state board of medical examiners fined one doctor who saw a new patient every six minutes during one of the traveling clinics — not enough time to provide adequate care.

Even the medical marijuana advocates in Montana now want the government to impose a bit stricter regulations. Might I suggest that Montanans emulate another Wild West state? New Mexico took a much more common-sense approach, never allowing marijuana advocates to hijack its state law, or at least not yet. The entire state of New Mexico only has about a dozen licensed medical marijuana purveyors (there are that many within a few blocks in downtown Boulder, Colorado), and getting a permit to use marijuana remains restrictive, as is usually the case with medicine. New Mexico, a state of about 2 million people, has about 2,500 licensed medical marijuana users, which is more reasonable considering that the drug only has limited uses for the very sick.

This from an FAQ on New Mexico’s Department of Health website:

Q: How do I apply for the Medical Cannabis Program?
A: Your physician must certify that you have an eligible condition, that the condition is debilitating and can not be helped by standard treatments, and that the benefits of medical cannabis usage outweigh the detriments. For post traumatic stress disorder, a psychiatrist’s diagnosis must be included. For glaucoma, an ophthalmologist must provide the diagnosis. For chronic pain, you need objective proof of severe chronic pain (X-rays, CT scans, MRIs) and receive two recommendations, one from your primary care physician and one from a specialist consulting on your case. The program has 30 days to review your application starting from when the program receives your complete application. If the Medical Director approves your application, the program will issue you a registry ID card.

In many states, medical marijuana has made a mockery of the medical practice. But in New Mexico, medical marijuana more closely mirrors real therapeutic care. Montana would do well to emulate it, and so would other states.

Posted in Addiction, Marijuana, Marijuana legalization, Medical marijuana, MJ lobby, Recovery, Substance abuse | Tagged , , , , , , , , , , , | 1 Comment

ATODblog:2010 in review

Posted on January 3, 2011 by

Wish I had more time to devote to this blog… Anybody else who thinks the same way I do about alcohol, tobacco and other drugs want to submit a post? Anyway, here’s the figures on readership for last year, courtesy of WordPress… not half bad:

Featured image

A Boeing 747-400 passenger jet can hold 416 passengers. This blog was viewed about 7,100 times in 2010. That’s about 17 full 747s.

In 2010, there were 27 new posts, not bad for the first year! There were 92 pictures uploaded, taking up a total of 4mb. That’s about 2 pictures per week.

The busiest day of the year was August 2nd with 250 views. The most popular post that day was About atodblog.com.

Where did they come from?

The top referring sites in 2010 were jointogether.org, facebook.com, mail.yahoo.com, msnbc.msn.com, and mail.live.com.

Some visitors came searching, mostly for atod blog, hookah bar, cigarette pack warnings, chewing tobacco, and floatopia santa barbara.

Attractions in 2010

These are the posts and pages that got the most views in 2010.

1

About atodblog.com July 2010
4 comments

2

Marijuana addiction: MJ lobby vs. science August 2010
12 comments

3

Local governments ignore laws against hookah lounges in California (not to mention their public health threat) November 2010
5 comments and 1 Like on WordPress.com,

4

Medical associations coming out against medical marijuana as the reality of state pot laws gets silly October 2010
11 comments

5

UK media fall for alcohol industry press release September 2010
2 comments

Posted in Addiction, Alcohol, Alcohol abuse, Alcohol taxes, Big Tobacco, Binge drinking, Cigarette warning labels, College drinking, Drug abuse, Healthcare reform, Integrated treatment, Marijuana, Marijuana legalization, Medical marijuana, MJ lobby, Painkiller abuse, Parity, Pot doc, Poverty, Prevention, Recovery, SBI, Second-hand smoke, Smoke-free, Smokeless tobacco, Social host, Substance abuse, Substance use disorder treatment, Tobacco, Tobacco and kids, Tobacco marketing, Treatment, Treatment until recovery, Underage drinking, Underage drinking parties | 2 Comments

Some good news from California: Smoking is waaaay down!

Posted on January 2, 2011 by

It's hard for Californians to imagine that people still smoke indoors in some states

These days, Californians don’t hear a lot of  good news about our state, not with budget cuts decimating our once vaunted education system, our parks and other public services. But one thing we’ve done right is quit smoking. My state is a world leader in reducing tobacco use, and other states and countries should follow our lead.

The most recent reporting shows that adult smoking is down to 13.1 percent in California, a drop from 22.7 percent in 1988 and much lower than the national average.

A Gallup poll that asked adults “Do you smoke?” found that about 21 percent answered affirmatively across the nation. That poll found that adult smoking tends to be lower in states where cigarette taxes and education levels are higher. The smokiest states are Kentucky and West Virginia, where 31 percent of adults smoke.

California’s success is due to its comprehensive tobacco control program that began in 1988 when voters approved Proposition 99, which increased cigarette taxes by 25 cents a pack, most of which is spent on tobacco control. Since Prop. 99, California’s declining smoking rate saved 1 million lives. The California Tobacco Control Program (CTCP) credits

“…grassroots programs designed and implemented by local health departments, community coalitions and organizations, statewide projects, ethnic networks, schools, and a statewide mass media campaign…”

But the most important factor was when California became the first state to go

Most Californians wouldn't dream of letting somebody light up in their home

smoke-free, beginning in 1995. A whole generation of Californians has grown up having never smelled indoor cigarette smoke. It began with the California Smokefree Workplace Act, which stated:

“No employer shall knowingly or intentionally permit, and no person shall engage in, the smoking of tobacco products in an enclosed space at a place of employment.”

Next to higher taxes, smoke-free public places and workplaces are the biggest motivation for quitting smoking. Many, many studies have shown that enacting and enforcing smoke-free places compels people to either quit or cut down their smoking, which is why the tobacco industry hates smoke-free laws. One of the main reason’s that California’s smoking rate is so low is that we went smoke free a long time ago, and it continues to pay off.

Here's what it's all about: California's lung cancer rate is much lower than the nation's

But as great a job as California is doing, the state must do more, and other states must do a whole lot more. Even with all of California’s anti-smoking measures, 43,000 people in the state die each year from tobacco-related illness. Tobacco use costs the state $16 billion a year. Nationwide, tobacco use kills 443,000 people each year, and about 49,000 of these deaths are caused by secondhand smoke.

California banned smoking near playgrounds, and many cities have also banned it near public entryways and other places. Two years ago, California banned smoking in cars when children are present. The latest front in the war against tobacco is smoke-free apartments. Research shows that second-hand smoke travels from apartment to apartment and affects non-smoking residents, and especially kids, who can’t choose where they can live. Smoke-free multi-unit housing, which is perfectly legal, will convince even more people to quit and help reduce smoking among low-income populations, where tobacco use is highest.

When it comes to tobacco control, the rest of the country needs to emulate California. When it comes to balancing the state budget… not so much.

Click image for more than you ever need to know about California and smoking

Posted in Big Tobacco, Recovery, Second-hand smoke, Smoke-free, Tobacco, Tobacco and kids, Tobacco marketing | Tagged , , , , , , , , | 2 Comments

A doctor’s opinion: Medical marijuana should never be smoked

Posted on December 27, 2010 by

[Dear readers, This post is by my brother, Ed Gogek, MD, an Arizona physician who was very active in opposing Arizona's new medical marijuana law. The following excerpt was written as comment on new regulations for the AZ law. His position is that regs should ban medical marijuana in the smokeable form. Here's a link to his blog, where the entirety of the post can be found. jg]

Ed Gogek, MD, opposed Arizona's medical marijuana law, which squeaked by with about 4,000 votes

As a doctor, I oppose dispensing medical marijuana in a form that can be smoked. The medical profession and others in public health have made a huge effort for several decades to eliminate the smoking of tobacco because it’s such a serious health hazard, and doctors should not recommend any substance to be smoked.

Research evidence shows that smoking marijuana probably causes respiratory problems and several types of cancer, including lung cancer. The evidence is not overwhelming, mostly because there have not been enough good studies, but it’s significant.

On several pro-marijuana websites I found the claim that “there is no direct evidence linking marijuana smoking to lung cancer in humans.” That is exactly what the tobacco industry said for decades after the first studies came out linking cigarette smoking with lung cancer. What they said was technically true; until recently we did not know for certain the exact mechanism by which smoking caused cancer. However, the statistical evidence was overwhelming, so the tobacco industry was being completely disingenuous and so are the pro-marijuana groups who say marijuana doesn’t cause cancer. Anyone who claims that marijuana does not cause cancer is ignoring the research.

Two studies showed no increase in cancer in marijuana users, but negative studies are not proof unless it happens repeatedly. Also, both studies have been criticized for bias, and I believe these criticisms are accurate. One large study (Tashkin 2006) of 1200 people with head, neck and lung cancer showed no increase in cancer in marijuana smokers. Tashkin was the same researcher who had previously found that marijuana caused pre-cancerous changes in the respiratory tract, so he was surprised to find no increased cancer risk.  That large study has been criticized for selection bias—marijuana users in the control group were more likely to also smoke cigarette than the marijuana users in the group with cancer, so they did not do a good job of controlling for cigarette smoking. This really throws doubt on the results.

One other study published in the American Journal of Public Health in 1997 (Sidney et al) that found marijuana smokers had no increase in cancer has been criticized for using subjects who were too young, so cancers would not have had time to develop.

There is also research showing increased cancer rates in marijuana smokers.

A New Zealand study published in the European Respiratory Journal in 2008 looked at 79 patients with lung cancer and found the risk of lung cancer increased by 8 percent for every joint-year (averaging one joint daily for one year) and 7 percent for every pack-year (averaging one pack of cigarettes daily for one year), leading them to conclude that smoking marijuana posed the same lung cancer risk as smoking cigarettes.

Three North African case studies showed a very strong link between marijuana smoking and lung cancer, but none of these studies controlled for tobacco use, so these results are questionable.

A 2009 study done at the Fred Hutchinson Cancer Research Center in Seattle and published in the journal Cancer found that men who smoked marijuana once a week had twice the risk of testicular cancer when compared to men who never used marijuana, and marijuana was most strongly linked to nonseminoma, the most aggressive form of testicular cancer.

Research published in the journal Urology in 2006 showed increased rates of bladder cancer in marijuana smokers. They also found that marijuana-smoking patients were younger at the time of diagnosis than most patients with bladder cancer. Cigarette smoking is a major risk factor for bladder cancer, but the researchers concluded that smoking marijuana may be as bad or worse than cigarette smoking as
a risk factor for bladder cancer.

In 1999, a study published in the journal Cancer Epidemiology found that squamous cell carcinoma of the head and neck increased with marijuana use and there was a strong dose-response curve, the heavier marijuana users had higher rates of cancer. However, in 2004, a study published in Cancer Research found no association between marijuana user and squamous cell carcinoma.

This is not a complete list of studies, but there aren’t many. So it is not enough to draw definitive conclusions on marijuana and cancer. However, the evidence that marijuana smoking is linked to cancer is far more substantial than the research supporting marijuana as treatment for most of the disorders listed in Arizona’s new medical marijuana law.  Also, remember, it took decades of heavy tobacco use by large swaths of the population before we had a definitive link between smoking and cancer.

Also, in November 2010 an article printed in the European Journal of Immunology described a possible mechanism by which smoking marijuana causes cancer and the research supporting this possible mechanism. If further studies support these findings, then we will have direct evidence linking marijuana smoking to cancer in humans.

Anyone who goes on the internet will find the pro-marijuana groups misrepresenting research. What they almost always do is take one study or one bit of information and run with it as if that were the whole story. That’s how Arizona ended up with a law that says marijuana is good for glaucoma even though the Glaucoma Foundation warns patients not to use marijuana because it could make their symptoms worse.

There are even pro-marijuana websites claiming that marijuana cures cancer. This comes from research showing that certain cannabinoids might have an anti-tumor effect, but the same research also showed that marijuana smoke contained many of the same carcinogens found in tobacco or that marijuana suppresses the immune system making cancer more likely, and the pro-marijuana groups never mention that.

The American Cancer Society points out on its website that it’s hard to study marijuana and cancer because so many marijuana users also smoke cigarettes and because it’s hard to study illegal drugs. British cancer researchers noticed the same problem. Both noted a weak link between marijuana and cancer based on very limited research. Not definitive, but not negligible.

One part of the research is very clear. We know for certain that marijuana smoke contains many of the same carcinogens as tobacco smoke, produces more tar than tobacco, and that the way people smoke marijuana (down to the roach, unfiltered, inhaling deeply, holding it in) delivers more tar to the lungs than the way people smoke tobacco.

Calfornia’s Office of Environmental Health Hazard Assessment ruled in 2009 that marijuana smoke is carcinogenic. They are not calling the marijuana plant a carcinogen, just the smoke. That seems right; the research shows a link between smoking marijuana and several types of cancer also commonly caused by smoking tobacco. There is no evidence that ingesting marijuana by other methods causes cancer.

Smoking marijuana is also linked to respiratory problems. Research shows that marijuana smokers have decreased respiratory function, increased airflow obstruction, and fewer of the anti-oxidants that protect against cancer and heart disease.

In summary, smoking marijuana has been implicated in several health problems including cancer. So no doctor should be recommending marijuana in a form that can be smoked. And states with medical marijuana laws, including Arizona, should not allow such a dangerous route of administration. Following the basic dictum, First, do no harm, doctors should always prescribe medications by the least harmful route of administration.

We always try to put medications in a form that can be taken orally. For people whose illness makes it hard to take a pill or to keep one down, we have skin patches and suppositories. The last resort is injecting medicine. But there is no precedent for a medication that is smoked, and for good reason. Smoking causes cancer and lung damage.

Posted in Marijuana, Marijuana legalization, Medical marijuana, MJ lobby, Recovery, Substance abuse | Tagged , , , , , , , , , , | 3 Comments

Lower the minimum drinking age to reduce college binge drinking? Studies show that’s as crazy as it sounds

Posted on December 27, 2010 by

Do these guys think everybody drinks like this?

With almost no evidence to back up their theory, a group of college presidents, nearly all from private schools, have been pushing to lower the drinking age because they think that would reduce binge drinking on their campuses. It’s called the Amethyst Initiative, and it’s always been shocking to me. Because college presidents should understand the importance of real research evidence when urging a “radical experiment,” as one researcher put it, that has serious public health and safety ramifications for young people. Instead, they offer no evidence at all for their views. Their website contains no research to support lowering the drinking age.

But now, there is evidence about their idea – and it refutes it. A study published in the January 2011 issue of the Journal of Studies on Alcohol and Drugs took the idea of the Amethyst Initiative and applied mathematical modeling to it. The research showed that the only campuses that might benefit from lowering the drinking age would be those with an extremely heavy drinking environment, a lack of enforcement at surrounding bars and – this is important – a radical misunderstanding about normal drinking. In other words, if most students thought that all other students drank a lot more than they really did. Such a misperception would have to be “extremely large,” one researcher said. And, there’s no evidence that it is. There’s no evidence that such a university campus actually exists. So lowering the drinking age would have no effect, the report concluded.

There are plenty of other studies, however, showing that lowering the drinking age is a

This problem could get a lot worse if it became legal for 18 year olds to drink. Courtesy of SAMHSA

really bad idea. Among them:

  • A 2009 study in Alcoholism: Clinical and Experimental Research showed that the minimum 21 legal drinking age saved 732 lives a year in the US since 1982 by reducing fatal accidents
  • A 2005 study in the American Journal of Public Health showed that significantly more alcohol-involved crashes occurred among 15-to 19-year-olds after New Zealand lowered its drinking age
  • A 2010 study in the Journal of Safety Research concluded that initiatives to lower the drinking age to 18 “ignore the demonstrated public health benefits” of the minimum 21 legal drinking age.

Besides, isn’t it cavalier for presidents of exclusive private colleges to urge lowering the drinking age to supposedly help their students, without considering the health and safety of underage youth who aren’t going to college?

Posted in Alcohol, Alcohol abuse, Binge drinking, College drinking, Recovery, Substance abuse, Underage drinking, Underage drinking parties | Tagged , , , , , , , | Leave a comment