Category: Illegal Drugs

— A single high dose of the hallucinogen psilocybin, the active ingredient in so-called "magic mushrooms," was enough to bring about a measurable personality change lasting at least a year in nearly 60 percent of the 51 participants in a new study, according to the Johns Hopkins researchers who conducted it.

Lasting change was found in the part of the personality known as openness, which includes traits related to imagination, aesthetics, feelings, abstract ideas and general broad-mindedness. Changes in these traits, measured on a widely used and scientifically validated personality inventory, were larger in magnitude than changes typically observed in healthy adults over decades of life experiences, the scientists say. Researchers in the field say that after the age of 30, personality doesn't usually change significantly.

"Normally, if anything, openness tends to decrease as people get older," says study leader Roland R. Griffiths, a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.

The research, approved by Johns Hopkins' Institutional Review Board, was funded in part by the National Institute on Drug Abuse and published in the Journal of Psychopharmacology.

The study participants completed two to five eight-hour drug sessions, with consecutive sessions separated by at least three weeks. Participants were informed they would receive a "moderate or high dose" of psilocybin during one of their drug sessions, but neither they nor the session monitors knew when.

During each session, participants were encouraged to lie down on a couch, use an eye mask to block external visual distraction, wear headphones through which music was played and focus their attention on their inner experiences.

Personality was assessed at screening, one to two months after each drug session and approximately 14 months after the last drug session. Griffiths says he believes the personality changes found in this study are likely permanent since they were sustained for over a year by many.

Nearly all of the participants in the new study considered themselves spiritually active (participating regularly in religious services, prayer or meditation). More than half had postgraduate degrees. The sessions with the otherwise illegal hallucinogen were closely monitored and volunteers were considered to be psychologically healthy

"We don't know whether the findings can be generalized to the larger population," Griffiths says.

As a word of caution, Griffiths also notes that some of the study participants reported strong fear or anxiety for a portion of their daylong psilocybin sessions, although none reported any lingering harmful effects. He cautions, however, that if hallucinogens are used in less well supervised settings, the possible fear or anxiety responses could lead to harmful behaviors.

Griffiths says lasting personality change is rarely looked at as a function of a single discrete experience in the laboratory. In the study, the change occurred specifically in those volunteers who had undergone a "mystical experience," as validated on a questionnaire developed by early hallucinogen researchers and refined by Griffiths for use at Hopkins. He defines "mystical experience" as among other things, "a sense of interconnectedness with all people and things accompanied by a sense of sacredness and reverence."

Personality was measured on a widely used and scientifically validated personality inventory, which covers openness and the other four broad domains that psychologists consider the makeup of personality: neuroticism, extroversion, agreeableness and conscientiousness. Only openness changed during the course of the study.

Griffiths says he believes psilocybin may have therapeutic uses. He is currently studying whether the hallucinogen has a use in helping cancer patients handle the depression and anxiety that comes along with a diagnosis, and whether it can help longtime cigarette smokers overcome their addiction.

"There may be applications for this we can't even imagine at this point," he says. "It certainly deserves to be systematically studied."

Along with the National Institute on Drug Abuse, this study was funded by the Council on Spiritual Practices, Heffter Research Institute and the Betsy Gordon Foundation.

Other Hopkins authors of the research include Matthew W. Johnson, Ph.D, and Katherine A. MacLean, Ph.D.

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Journal Reference:

1. K. A. MacLean, M. W. Johnson, R. R. Griffiths. Mystical Experiences Occasioned by the Hallucinogen Psilocybin Lead to Increases in the Personality Domain of Openness. Journal of Psychopharmacology, 2011; DOI: 10.1177/0269881111420188

Experts from Kingston University have devised a new questionnaire to detect behaviour such as mephedrone use. The aim is to pinpoint exactly how widespread the abuse of substances like mephedrone, commonly called meow meow, is by using a method of data collection that aims to filter out respondents who might not be telling the truth.

An international team led by scientists from London's Kingston University has developed a fresh approach to determining just how widely used designer drugs are. The aim is to pinpoint exactly how widespread the abuse of substances like mephedrone, commonly called meow meow, is by using a method of data collection that aims to filter out respondents who might not be telling the truth.

The researchers, led by Professor Andrea Petroczi, have devised a new form of questionnaire which is aimed at getting large survey groups to admit to behaviour which they might prefer to keep secret. The team found that up to one in 10 young people in the United Kingdom had taken mephedrone in the previous three months.

The team surveyed young people (with a majority aged between 18 and 27) in the London and Bangor areas using a new method called the Single Sample Count. The technique hides a sensitive question, in this case one about mephedrone use, among a series of seemingly trivial questions with yes or no answers, such as asking participants "Is your mother's birthday in the first half of the year?."

"In the past it has been shown that this kind of method always gives a higher rate of people admitting to drug use than if they're just asked outright," Professor Petroczi from Kingston University's School of Life Sciences said. "Another key feature of this simple method is that there is absolutely no way to relate the individual answers back to the respondents, so they are protected even if the researcher sees their anonymous response."

The results revealed that up to 10 per cent of the 318 young people questioned admitted using mephedrone at least once in the period leading up to it being classified as a class B controlled substance in April 2010. Before then, the laboratory-produced drug had been a so-called 'legal high'. It has a similar effect to amphetamines, ecstasy or cocaine. But it also causes nausea, palpitations and vomiting. The Office for National Statistics reported that there were six deaths involving mephedrone in 2010, the first year it had been mentioned on death certificates in England and Wales.

"The results are broadly consistent with similar studies into the prevalence of mephedrone and underline just how much of a problem the drug is with young users," Professor Petroczi said. "The proliferation of designer drugs is deeply concerning because of the very serious health risks. Drugs like mephedrone are usually untested in terms of exactly how dangerous they can be."

To help validate the questionnaire results, a new test for mephedrone in hair was also developed by Kingston University scientists. The results found that almost four per cent of the sample contained mephedrone, suggesting regular use.

"For the mephedrone to be detectable in your hair, it has to have been used more than once," Professor Declan Naughton, a co-author of the study explained. "So the figure is likely to be the habitual users, and the remainder of the 10 per cent figure from the questionnaire composed of those who have taken it just once."

A leading American expert in substance abuse said the Kingston research was significant. "Interestingly, mephedrone has not become well known in the United States at the moment, although that situation may change as time goes by," Professor Harrison Pope from Harvard University said. "Certainly the prevalence estimate of 10 per cent in the United Kingdom in this study is worrisome from our American vantage point, because it may point to rates of usage rising on our side of the Atlantic in the future too."

The study has been published in the journal Substance Abuse Treatment, Prevention and Policy and saw the Kingston University researchers work with colleagues from Bangor University, the University of Northern Colorado and Eötvös Loránd University in Budapest.

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Journal Reference:

1. Andrea Petróczi, Tamás Nepusz, Paul Cross, Helen Taft, Syeda Shah, Nawed Deshmukh, Jay Schaffer, Maryann Shane, Christiana Adesanwo, James Barker, Declan P Naughton. New non-randomised model to assess the prevalence of discriminating behaviour: a pilot study on mephedrone. Substance Abuse Treatment, Prevention, and Policy, 2011; 6 (1): 20 DOI: 10.1186/1747-597X-6-20

— An enzyme that appears to play a role in controlling the brain's response to nicotine and alcohol in mice might be a promising target for a drug that simultaneously would treat nicotine addiction and alcohol abuse in people, according to a study by researchers at the Ernest Gallo Clinic and Research Center, affiliated with the University of California, San Francisco.

Over the course of four weeks, mice genetically engineered to lack the gene for protein kinase C (PKC) epsilon consumed less of a nicotine-containing water solution than normal mice, and were less likely to return to a chamber in which they had been given nicotine.

In contrast, normal mice steadily increased their consumption of nicotine solution while the mice lacking PKC epsilon did not.

The study was conducted by Gallo senior associate director and investigator Robert O. Messing, MD, UCSF professor of neurology, and Gallo researcher Anna M. Lee, PhD.

In normal mice, as in humans, nicotine binds to a certain class of nicotinic receptors located on dopamine neurons, which causes dopamine to be released in the brain. Dopamine creates a feeling of enjoyment, and thus prompts a sense of reward. Lee and Messing found that mice lacking PKC epsilon are deficient in these nicotinic receptors.

The study appears in the online Early Edition of the Proceedings of the National Academy of Sciences for the week of September 12, 2011.

The finding complements earlier research in which Messing found that mice genetically engineered to lack the PKC epsilon enzyme drank less alcohol than normal mice and were disinclined to return to a chamber in which they had been given alcohol.

"This could mean that these mice might not get the same sense of reward from nicotine or alcohol," said Messing. "The enzyme looks like it regulates the part of the reward system that involves these nicotinic receptors." The reward system is a complex of areas in the brain that affect craving for nicotine, alcohol and other addictive substances.

The next step in the research, said Messing, would be to develop compounds that inhibit PKC epsilon. The ultimate goal, he said, would be medications that could be used "to take the edge off of addiction by helping people get over some of their reward craving."

The research was supported by grants from the U.S. Public Health Service and the Canadian Institute of Health Research, and by funds provided by the State of California for medical research on alcohol and substance abuse through UCSF.

Universities and colleges need to do more to protect young adults from the dangers of illicit stimulant use and to educate them about harms, argue the authors of an editorial in CMAJ (Canadian Medical Association Journal).

Students use stimulants to keep them alert to enhance their academic performance, although the perceived benefits are questionable.

"The vast majority of the evidence shows no cognitive improvements with the use of stimulants when compared with placebo in healthy individuals. In short, students who think simply popping a pill will improve their grades or give them new-found academic abilities are sorely mistaken," write Dr. Daniel Rosenfield, CMAJ Editor-in-Chief Dr. Paul Hebert and coauthors.

"Abuse of prescription medications such as methylphenidate and atomoxetine has been estimated at an alarming rate ranging from 5% to 35%. Without action, some of our best and brightest minds are at risk," they state.

Many students are unaware of the potential side effects and harms associated with stimulants. When stimulants are used without medical supervision, used for the wrong purpose or taken inappropriately (i.e., snorting or injecting), harmful effects — such as irregular heart beat, overdose, depression, addiction and even death — are likely.

As universities and colleges are common venues for abuse of stimulants, given the perception that they boost grades, students need to recognize the seriousness of the issues. Universities need to engage students in focused health education campaigns that debunk myths and expose risks, and identify and address the root cause of stimulant use.

The authors conclude: "Like doping in sports, abuse of stimulants by our best and brightest students should be denormalized by being viewed as cheating or substance abuse, pure and simple."

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Journal Reference:

1. D. Rosenfield, P. C. Hebert, M. B. Stanbrook, K. Flegel, N. E. MacDonald. Time to address stimulant abuse on our campuses. Canadian Medical Association Journal, 2011; 183 (12): 1345 DOI: 10.1503/cmaj.111149

Scientists report the development of much needed new tests to help cope with a wave of deaths, emergency room visits and other problems from a new genre of dangerous designer drugs sold legally in stores and online that mimic the effects of cocaine, ecstasy and marijuana.

They spoke at the 242nd National Meeting & Exposition of the American Chemical Society (ACS), being held in Denver.

The reports, among more than 7,500 on the ACS agenda, focus on drugs sold as "bath salts," "plant food," "incense" and other products with colorful names, such as "Ivory Wave," "Red Dove" and "legal marijuana." They provide users with a high, but many have not yet been made illegal and are undetectable with current drug tests. In one presentation on these "legal highs," a United Kingdom researcher reported a new method to trace the source of the substances in "bath salts." In the other, a U.S. researcher discussed the challenges facing law enforcement and policy makers in regulating synthetic versions of marijuana.

Oliver Sutcliffe, Ph.D., and his collaborators reported the successful use of a method called isotope ratio mass spectrometry (IRMS) to determine who is making bath salts — drugs that can cause euphoria, paranoia, anxiety and hallucinations when snorted, smoked or injected — and which chemical companies supplied the raw materials. He and his co-workers are based at the University of Strathclyde and the James Hutton Institute in the U.K.

"With the new method, we could work backwards and trace the substances back to the starting materials," said Sutcliffe. IRMS measures the relative amounts of an element's different forms, or isotopic ratio. "This method was successful because the isotopic ratio of the starting material is transferred like a fingerprint through the synthesis," he explained.

"Bath salts" first garnered major media attention in the U.K. in early 2010, and then became a problem in the U.S. These products are not in the supermarket soap aisle — they are sold on the Internet, on the street and in stores that sell drug paraphernalia. They are sold in small individual bags for as low as $20 each for the real purpose of providing a cheap, legal high.

The powders often contain mephedrone, which is a synthetic compound, structurally related to methcathinone, which is found in Khat — a plant that is illegal in many countries, including the U.K. and the U.S. Usually, that would mean that these compounds (and derivatives thereof) would be illegal in those countries too, but because the bath salts are labeled "not for human consumption," they get around this restriction and other legislation governing the supply of medicines for human use. However, Florida and Louisiana — two hotspots of bath salts abuse — specifically banned the substances. U.K. officials banned the import of bath salts, which may lead some in the drug trade to set up clandestine labs on U.K. soil, said Sutcliffe. The new method provides law enforcement with a tool to track down these bath salts manufacturers.

In previous work, Sutcliffe developed the first pure reference standard for mephedrone, as well as the first reliable liquid chromatography test for the substance, which could be easily run in a typical law enforcement lab. The team is also developing a color-change test kit for mephedrone, which he estimates may be available by the end of the year.

In another presentation, Robert Lantz, Ph.D., from the Rocky Mountain Instrumental Laboratories, described another high that is legal in most of the U.S. — synthetic cannabinoids marketed as incense, a spice product or "legal marijuana" that give a high similar to marijuana without showing up in conventional drug tests.

"We can detect synthetic cannabinoids with modern analytical chemistry techniques, such as liquid or gas chromatography coupled to mass spectrometry, but these assays are too expensive for the 5,000-10,000 urine samples that most drug testing labs receive each day," said Lantz. Most labs screen for drugs with less expensive antibody assays, but because the structures of these substances are so dissimilar, different antibodies would likely be required for many of them, driving up the cost of a more comprehensive test.

Synthetic cannabinoid abuse rose sharply in 2010, according to U.S. poison control centers, up to 2,863 compared to only 14 in 2009. About 200 synthetic cannabinoids exist, but the U.S. Drug Enforcement Agency (DEA) banned only five of those. A handful of states, such as Washington, Georgia and Colorado, banned five of them, but they are not always the same five that the DEA banned. "The states banned several specific compounds without a particular basis for their choices," Lantz pointed out.

Colorado recently passed a law banning any substance that binds to a cannabinoid receptor in the human body. "The bill was well-intentioned, but technically, the new law not only covers synthetic cannabinoids, but also endocannabinoids, which are naturally occurring substances that the human body produces to regulate many normal processes," said Lantz.

 Adolescents who misuse controlled medications (e.g., pain, stimulant, sleeping and antianxiety medications) for which they have a legitimate prescription may be more likely to abuse other substances and to sell, give or trade their controlled medications to other individuals, according to a report in the August issue of Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals.

According to background information in the article, U.S. children and teens have increasingly received prescriptions for controlled medications. "Despite the importance of controlled medications in treating childhood and adolescent disorders, a consequence of this increase in prescribing may be a concomitant rise in medical misuse, diversion of controlled medications, and nonmedical use of controlled medications among adolescents," write the authors. They define "medical misuse" as "the use of a controlled psychotherapeutic medication by a patient in a manner not intended by the prescribing health care professional, including (but not limited to) not following the prescribed dosage, using intentionally to get high, not taking the medication within a prescribed interval, or co-ingesting with alcohol or other drugs."

Sean Esteban McCabe, Ph.D., from the University of Michigan, Ann Arbor, and colleagues conducted a Web-based survey from December 2009 to April 2010. The 2,597 respondents who completed the survey were students at middle schools and high schools in two southeastern Michigan school districts. The average age was 14.8 years, 65 percent of respondents were white and 51.1 percent of participants were female. The survey included standard measures of substance use (cigarette smoking in the past month, binge drinking in the past two weeks, nonmedical use of prescription medication and marijuana and other illicit drug use in the past year); questions about medical use, misuse and diversion (selling, giving away or trading) of controlled medications; and two drug-screening tests.

Of the 18 percent of respondents who said that during the past year they had used, for medical purposes, one of the controlled medications mentioned, 22 percent also said they had misused these medications, mostly by taking too much. Those defined as frequent users of controlled medications (at least 10 instances) were more likely than less-frequent users to engage in misuse. Prevalence of misuse was greater among frequent users of pain, sleeping and antianxiety medications. Adolescents who misused their controlled medications were also more likely to use alcohol and other drugs, and to divert these medications to others.

"Despite the importance of controlled medications for the treatment of pediatric disorders, our results suggest that a consequence of the greater availability of these medications may be an increase in their nonmedical use," write the authors. "Clinicians must balance the risks and benefits of controlled medication use with the abuse potential when assessing, treating, and monitoring their patients." The researchers also urge clinicians to "consider prescribing controlled medications with less potential for substance abuse and diversion."

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Journal Reference:

1. S. E. McCabe, B. T. West, J. A. Cranford, P. Ross-Durow, A. Young, C. J. Teter, C. J. Boyd. Medical Misuse of Controlled Medications Among Adolescents. Archives of Pediatrics and Adolescent Medicine, 2011; 165 (8): 729 DOI: 10.1001/archpediatrics.2011.114

Researchers from the Universities of Bonn and Mainz have discovered a mechanism that seems to protect the brain from aging. In experiments with mice, they switched off the cannabinoid-1 receptor. As a consequence, the animals showed signs of degeneration — as seen in people with dementia — much faster.

The research results are presented in a current issue of the Proceedings of the National Academy of Sciences (PNAS).

Humans are getting older and older, and the number of people with dementia is increasing. The factors controlling degeneration of the brain are still mostly unknown. However, researchers assume that factors such as stress, accumulation of toxic waste products as well as inflammation accelerate aging. But, vice versa, there are also mechanisms that can — like a bodyguard — protect the brain from degenerating, or repair defective structures.

Researchers from the Universities of Bonn and Mainz have now discovered a hitherto unknown function of the cannabinoid-1 receptor (CB1). A receptor is a protein that can bind to other substances, triggering a chain of signals. Cannabinoids such as THC — the active agent in cannabis sativa — and endocannabinoids formed by the body bind to the CB1 receptors. The existence of this receptor is also the reason for the intoxicating effect of hashish and marijuana.

Not only does the CB1 receptor have an addictive potential, but it also plays a role in the degeneration of the brain. "If we switch off the receptor using gene technology, mouse brains age much faster," said Önder Albayram, principal author of the publication and a doctoral student on the team of Professor Dr. Andreas Zimmer from the Institut für Molekulare Psychiatrie at the University of Bonn. "This means that the CB1 signal system has a protective effect for nerve cells."

Mice prove their brain power in a pool

The researchers studied mice in different age categories — young six week old animals, middle-aged ones at five months, and those of an advanced age at 12 months. The animals had to master various tasks — first, they had to find a submerged platform in the pool. Once the mice knew its location, the platform was moved, and the animals had to find it again. This was how the researchers tested how well the rodents learned and remembered.

The animals in which the CB1 receptor had been switched off (the knock-out mice) clearly differed from their kind. "The knock-out mice showed clearly diminished learning and memory capacity," said Privatdozent Dr. Andras Bilkei-Gorzo from Professor Zimmer's team, who led the study. So, animals that did not have the receptor were less successful in their search for the platform. "In addition, they showed a clear loss of nerve cells in the hippocampus," he explained further. This part of the brain is the central area for forming and storing information. In addition, the researchers found inflammation processes in the brain. As the mice advanced in age, the degenerative processes became increasingly noticeable.

Amazing parallels with the human brain

The animals with the intact CB1 receptor, to the contrary, did clearly better with regard to their learning and memory capabilities, as well as the health of their nerve cells. "The root cause of aging is one of the secrets of life," commented Albayram. This study has begun to open the door to solving this enigma. The processes in the mouse brains have a surprising number of parallels with age-related changes in human brains. So, the endocannabinoid system may also present a protective mechanism in the aging of the human brain.

The principal author cautioned, "This will require additional research." The scientists would like to better understand the mechanism by which CB1 receptors protect the brain from inflammation processes. And based on these signal chains, it might then be possible to develop substances for new therapies.

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Journal Reference:

1. O. Albayram, J. Alferink, J. Pitsch, A. Piyanova, K. Neitzert, K. Poppensieker, D. Mauer, K. Michel, A. Legler, A. Becker, K. Monory, B. Lutz, A. Zimmer, A. Bilkei-Gorzo. Role of CB1 cannabinoid receptors on GABAergic neurons in brain aging. Proceedings of the National Academy of Sciences, 2011; 108 (27): 11256 DOI: 10.1073/pnas.1016442108

 College athletes tend to be less likely than their non-athlete peers to smoke marijuana. But when they do, they may have some different reasons for it, according to a study in the July issue of the Journal of Studies on Alcohol and Drugs.

Past studies have shown that athletes generally smoke marijuana less often than other college students do.

"But there is still a pretty large number who choose to use it," said Jennifer F. Buckman, Ph.D., of the Center of Alcohol Studies at Rutgers University in Piscataway, New Jersey.

Because marijuana could have ill health effects — and possibly hurt athletic performance — that begs the question of why college athletes would use it, according to Buckman.

So for the new study, she and her colleagues surveyed 392 college athletes and 504 non-athlete students about marijuana use. Among men, one-third of athletes said they'd used the drug in the past year, versus half of non-athletes; the same was true of 25% of female athletes and 48% of non-athletes.

Overall, athletes and non-athletes shared many of the same risk factors for marijuana use such as being white, being a cigarette smoker and having an exaggerated perception of how many of their peers use the drug. But there were some differences too.

"One thing that stood out is that athletes were more likely to use marijuana because they thought it was pleasurable," Buckman said.

They were less likely, on the other hand, to use the drug for reasons like dealing with stress. That suggests that athletes largely smoke marijuana recreationally, rather than as a way of coping with life problems.

The exception, though, might be male athletes who keep using marijuana during their competitive season. The study found that these athletes reported more problems with anxiety and negative mood, and appeared more likely to use the drug for coping with stress compared with the male athletes who avoided marijuana during their competitive season.

"That's a really interesting finding, and it's a direction for research to go in the future," Buckman said. "What are the stressors for these athletes? Is it academic? Is it the athletic competition?"

The ultimate goal in studies like these, Buckman noted, is to uncover factors that seem to influence drug use, then develop specific messages most likely to make a difference with a specific group.

As an example, she pointed to the finding that female students with body-image worries were more likely to use marijuana than women without such concerns. Because the survey was done at one time point, it's not clear which came first: the marijuana use or the poor body image.

But since marijuana is well known to cause the "munchies," and particularly a yen for sweets, it's possible that the drug use came first.

Whatever the reason, college women — and especially athletes who need to stay fit — might listen to anti-marijuana messages that emphasize the effects on eating.

More studies are needed to uncover the reasons that young people start using marijuana, despite the potential health and legal consequences, according to Buckman.

"This is a very commonly used drug," Buckman said, "and we just need to understand more about the factors that influence people to use it."

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Journal Reference:

1. Jennifer F. Buckman, David A. Yusko, Samantha G. Farris, Helene R. White, Robert J. Pandina. Risk of Marijuana Use in Male and Female College Student Athletes and Nonathletes. Journal of Studies on Alcohol and Drugs, Volume 72, 2011 > Issue 4: July 2011 

 In the cover article of this month's Journal of the American Dental Association, a group of nine dentists, pharmacists, and addiction experts provides new research and recommendations to help dentists combat, rather than contribute to, abuse of addictive painkillers.

The Obama administration turned a bright spotlight on prescription painkiller abuse in April when the Office of National Drug Control Policy released a national action plan and a statement from Vice President Joe Biden. With a cover article in the July edition of the Journal of the American Dental Association (JADA), dentists focus that spotlight on themselves both as major sources of opioid drugs and as professionals with largely untapped power to recognize and reduce abuse.

Many dentists really haven't even perceived there to be a problem," said George Kenna, an assistant professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, an addiction psychologist at the Center for Alcohol and Addiction Studies, and the corresponding author of the article. "Dentists write the third-most prescriptions for immediate release opioids in the United States, but they often don't know the appropriate number of doses to prescribe, how many doses a patient uses, or most importantly what patients do with the leftover tablets they have. Just ask someone the last time they threw away opioid prescriptions in particular. These leftover tablets — accumulated from various sources, not just dentists — that are often left in closets across the country are the primary source for prescription drug use initiation for children and adolescents."

As outlined by the administration's policy, facilitating ways to reduce the number of leftover painkillers such as hydrocodone and oxycodone that can become a supply of drugs in the home for those who would abuse them, dentists and other prescribers would be taking a significant step, said Kenna who is also a pharmacist. The National Survey on Drug Use and Health has found that seven in 10 people who have used painkillers nonmedically got the drugs through a family member or friend who had a prescription.

Last year Kenna helped lead a meeting of dentists and fellow addiction experts and pharmacists at the Tufts Health Care Institute Program on Opioid Risk Management, where he serves as a scientific adviser. The group produced this month's cover article for JADA, which offered several recommendations for dentists, including:

• Discuss with patients whether they need an opioid for their pain and how likely they are to use what you prescribe.
• Consider writing small quantities and limit refills.
• Do not prescribe drugs to patients you do not know; be suspicious of those who claim their drugs were lost or stolen.
• Use prescription monitoring programs (i.e., state databases), if available, to verify drug-use history.
• Advise patients either to destroy or lockup any excess medication.
• Keep prescription pads locked up.

In the article, the nine authors also call for more research to make the most effective use of opioid and non-opioid painkillers, for instance to determine how much painkiller and which kind patients really need. Without enough evidence to guide them, dentists have often felt obliged to prescribe opioids too often and in too great a quantity, Kenna said.

"Some new data show that ibuprofen as an anti-inflammatory does as well as many painkillers to kill pain for many dental procedures," Kenna said.

One in two dentists surveyed

Despite the large role dentists have as painkiller prescribers, there has been very little research on dentists' prescribing practices and experiences, particularly in the context of opioid addiction. To inform their discussion, the group commissioned a survey in 2010, led by Michael O'Neil, a pharmacy professor at the University of Charleston in West Virginia. In all, 52 percent of the state's dentists responded.

The survey revealed that nine in 10 of the dentists surveyed prescribed opioids in the prior year. Two-thirds prescribed between 10 and 20 doses of the painkillers, but 41 percent acknowledged that patients would probably have some left over.

The survey also found some evidence that dentists can sometimes be shy about raising substance abuse as an issue with patients, even as they realize they are sometimes being used to get drugs. One in three of the dentists said they did not routinely ask new patients about substance abuse, but 58 percent of the dentists said they believed they have been the victim of prescription fraud or theft.

While dentists should guard against over-prescribing addictive drugs, especially to patients they don't know well, Kenna said, they retain an obligation to help all patients, even ones who are addicted, to manage pain.

"There are ways that dentists can work with patients," he said. "People who have a substance abuse problem do have legitimate pain. They do have a right to have some pain control and may even need more. But you hope there is a family member who will take control and make sure they only take the recommended dose."

For all the things dentists could do, especially with more research to clarify the best prescribing practices, Kenna acknowledged that dentists are not currently compensated for the time required to investigate the drug use preferences and habits of their patients.

Kenna said he hopes to learn more about how the profession approaches opioids and addiction with a national survey of dentists.

"It's a growing problem in the United States," he said. "It's a serious problem."

In addition to Kenna and O'Neil, other authors of the paper were lead author Richard Denisco of the National Institute for Drug Abuse, Ronald Kulich of Massachusetts General Hospital, Paul Moore of the University of Pittsburgh, William Kane of the Missouri Dental Association Well Being Program, Noshir Mehta of Tufts University, Elliot Hersh of the University of Pennsylvania, and Nathaniel Katz, director of the Tufts opioid risk management program.

Some support for writing the article came from King Pharmaceuticals, a subsidiary of Pfizer that makes an opioid drug that is formulated to prevent abuse.

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Journal Reference:

1. Richard C. Denisco et al. Prevention of prescription opioid abuse The role of the dentist. The Journal of the American Dental Association, July 1, 2011 vol. 142 no. 7 800-810 [link]

 Marijuana is the most prevalent illicit drug used by teenagers and adults around the world. Nearly a third of high school students in the United States report smoking it, and most high schoolers say they have access to the drug.

To many people, smoking pot is no big deal. They cite reasons such as: "it isn't dangerous or addictive" and "everybody is doing it."

Denise Walker, co-director of the University of Washington's Innovative Programs Research Group, disagrees.

"It's not a risk-free drug," she said. "Lots of people who use it do so without problems. But there are others who use it regularly — almost daily — and want to stop but aren't sure how."

Walker hopes to help these people, many of whom feel stigmatized by their drug use. She is lead author of a paper showing that a brief, voluntary conversation with an adult led to up to a 20 percent decrease in marijuana use for teenagers who frequently used the drug. The paper was published online May 30 in the journal Psychology of Addictive Behaviors.

Teenagers face greater risks from regular marijuana use compared with adults, said Walker, who is also a UW research assistant professor of social work.

"Adolescence is a big developmental period for learning adult roles. Smoking marijuana regularly can impede development and school performance, and it sets kids up for other risky behaviors," she said.

Walker and her co-authors investigated how a two-session, "non-finger wagging" approach called Teen Marijuana Check-Up could encourage teens to reduce their marijuana use.

"The majority of people who need help aren't getting it and they don't think they need it," Walker said. Users are ambivalent about their drug use, Walker reported, and there are aspects of using marijuana they enjoy.

"However, many teens also have concerns about their use, even if they're not sharing them with family or friends," she said. If a convenient and easy opportunity to weigh the pros and cons of their drug use is offered that isn't "shaming or blaming," kids will participate in it voluntarily, she said.

The researchers went to high school classrooms and gave short presentations describing myths and facts about marijuana, common reasons why teens smoke it and its health and behavior consequences.

The researchers told the students about the study, saying it was intended to give feedback on — not treat — each student's marijuana use. Students could volunteer privately. Of about 7,100 students who heard about the study, 619 volunteered and 310 met its criterion of smoking marijuana regularly.

The participants, ninth through 12th graders attending Seattle public schools, had two one-on-one meetings with health educators. During the meetings, which lasted 30-60 minutes each over two weeks, the health educators used one of two approaches:

• Motivational interviewing, in which the health educator and student discussed the student's marijuana use and how it might be interfering with the student's life, goals and personal values, and the health educator told the student about social norms of how much others use the drug.
• An educational approach in which a PowerPoint presentation described current marijuana research and health and psychological effects of marijuana use.

Participants in the motivational interviewing group started the study using marijuana 40 out of the previous 60 days. Three months after counseling they had decreased their use 20 percent, to 32 out of 60 days. After a year they still showed a 15 percent decrease, 34 days out of 60.

Participants in the educational treatment group had slower results, reporting an 8 percent decrease from 38 to 35 days out of 60 days three months after the treatment ended. A year later, they reported using marijuana 34 of 60 days, an 11 percent overall drop.

The researchers called the findings "encouraging in that apparently meaningful reductions in cannabis use resulting from the brief meetings were sustained over a relatively lengthy period of time."

Walker said that the low-burden, low-cost program could be disseminated to drug and alcohol counselors in schools. The program "is supposed to attract people who aren't ready for a full treatment, but are interested in having a conversation with a professional trained to discuss concerns with substance use," she said.

The study was funded by the National Institute on Drug Abuse. Co-authors are Robert Stephens, Josephine DeMarce, Brian Lozano and Sheri Towe at Virginia Tech University and Roger Roffman and Belinda Berg at the UW.

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Journal Reference:

1. Denise D. Walker, Robert Stephens, Roger Roffman, Josephine DeMarce, Brian Lozano, Sheri Towe, Belinda Berg. Randomized controlled trial of motivational enhancement therapy with nontreatment-seeking adolescent cannabis users: A further test of the teen marijuana check-up.. Psychology of Addictive Behaviors, 2011; DOI: 10.1037/a0024076