The Rosenthal Report - October 2016

Rosenthal Reports
Marijuana Highlights
The Good News

The good news isn't all that good. The initial report from SAMHSA (Substance Abuse and Mental Health Services Administration) on findings of the National Survey of Drug Use and Health for 2015 shows a sharp decline in adolescent use of cigarettes and alcohol. Teen cigarette use has fallen by more than two-thirds since 2002 and alcohol use by nearly half. But at 7.0 percent, current (past month) use of marijuana by adolescents has remained at much the same level over the past decade.

A slight dip in teen use from the previous year and a significant decline from a peak in 2009, along with recent levels of adolescent heroin use, encourage agency officials to describe the current data as offering, "hope that marijuana and heroin use may be slowing down." What has clearly slowed down is the prevalence of adolescents with marijuana use disorders—either dependence on the drug or abuse of it—for the survey found this number falling from 4.3 percent of adolescents to 2.6 percent since 2002.

The Bad News

That's the increase in adult use. For young adults (18 to 25), the level of current (past month) use—now stands at just under 20 percent (19.8)—and has been creeping up from l6.6 percent since 2008. The level of current use for older adults increased by more than half again as much during the same seven-year period from 4.2 percent to 6.5 percent.  Should the increase in adult use concern us? You bet it should. Recent articles and editorials in the American Journal of Psychiatry point to the increase in adult use, with low levels of risk awareness, increased incidence and severity of cannabis use disorder, higher risk of death and psychosis (including schizophrenia), and a troubling low rate of treatment.

Our friends at Smart Approaches to Marijuana (SAM) flagged a new study by Quest Diagnostics, a major drug testing firm that found the rate of workers testing positive for marijuana has increased by 47 percent since 2011. This increase over the past three years followed a long period of declining drug use in the workplace and is clearly a reflection not simply of legalization and the quasi-legalization of medicalized marijuana, but also of what the author of a Journal of Psychiatry article calls "the increasingly accepting social attitudes toward marijuana use."

The Scary News

Psychiatrists are well aware that a connection exists between adolescent marijuana use and psychosis. The article “Concurrent and Sustained Cumulative Effects of Adolescent Marijuana Use on Subclinical Psychotic Symptoms” in the recent American Journal of Psychiatry nailed down some of the specific in a five-year study of more than a thousand teen-age boys.

Researchers at the University of Pittsburgh and Arizona State found that for each year the boys smoked marijuana 52 or more times they increased the risk of persistent subclinical psychotic symptoms by 21 percent. For each year of weekly use the chance of experiencing paranoia rose 133 percent and experiencing hallucinations rose 92 percent. All in all, the study should put "paid" to the notion that pot is pretty harmless stuff.


Risk Raising Synthetics

Complicating the already complex opioid overdose epidemic is the increasing use of powerful synthetic narcotics to boost the potency of heroin. From New England to California, authorities are finding growing numbers of overdose victims dosing themselves with heroin cut with fentanyl, a fast acting, short lasting synthetic painkiller widely used in medicine and 100 times stronger than morphine. In Ohio, the number of fentanyl overdose cases rose from 84 in 2013 to close to 1,500 in 2015.

Recently, carfentanil, a brawny cousin of fentanyl, showed around Cincinnati and in southern Indiana along the Kentucky border. A synthetic opioid used by veterinarians to sedate large animals (including elephants), carfentanil has 10,000 times the strength of morphine. During just one week this past August, it was responsible for close to 200 overdose cases and at least four deaths in the Cincinnati area. The DEA has issued a nationwide warning about carfentanil and NIDA has alerted authorities in both Ohio and Florida.

The danger low-cost, high-powered synthetics pose isn’t only increasing the overdose potential of drugs sold as heroin. They also are being used in counterfeit painkilling pills. The death of singer, songwriter, and musical icon Prince was caused by fentanyl in a counterfeit pill labeled Watson 36 that allegedly contained only hydrocodone and acetaminophen.

Our Medicated Kids

Pioneers in the study of attention deficit hyperactivity disorder (A.D.H.D.) have long decried the growing number of children now being diagnosed with A.D.H.D. That number grew from six hundred thousand in 1990 to six million by 2014. It is still growing, although there are no laboratory tests to confirm the diagnosis, which is based on subjective evaluation and screening for symptoms of inattention, hyperactivity, and impulsive behavior. Medication has become the standard response, and the great majority of the diagnosed are prescribed Ritalin, Adderall, or similar stimulants.


Fewer than one in three receives the behavior therapy that should accompany medication. And only half the diagnosed preschoolers receive the behavior therapy recommended as the first line of treatment by the American Academy of Pediatrics.

Now, New York Times reporter Alan Schwarz tells how all this came about, blowing the whistle on what he describes as one of the world’s most aggressive marketing campaigns. His book ADHD Nation tells how an alliance of drug companies, academic psychiatrists, policy makers, and celebrity pitchmen (what he calls “the A.D.H.D. industrial complex”) has sold the nation and the world, not on drugs, but—in the guise of awareness—on A.D.H.D. itself.

“Attention deficit hyperactivity is real,” says Schwarz, who opens his book with that sentence. But disorders of attention, once thought to be relatively rare (affecting only about three percent of preadolescents) have come to be routinely diagnosed, affecting more than 14 percent of American boys.  And who is it that is diagnosed? In the classroom it’s most often the youngest children in a class.  In the pediatrician’s office it’s likely to be allegedly under-achieving children of parents who believe the right pills will turn them into academic champions. Moreover, the drugs are now being prescribed for two-and-three year olds, which one pediatric critic of practice calls no more than “a quick fix for an unruly child.”

O.D. Fatalities as a Campaign Issue

Under the headline “Why It Matters: Issues at Stake in the Election,” the Associated Press recently listed and briefly described 17 pressing issues facing the nation, putting Iran first on the list and free trade agreements last. In thirteenth place was the article’s capsule summary of the “Opioid Epidemic,” leading with a single sentence citing the nation’s 28,000 opioid overdose deaths in 2014. The cause, according to AP, was the quadrupling of prescription painkiller sales since the start of the millennium. What is needed now are more dollars for “prevention, treatment and recovery services.”

Although the addiction epidemic was prominently featured in the Republican’s early and overcrowded nomination debates, it hasn’t surfaced much since the party conventions and wasn’t mentioned by either candidate in the first of the presidential debates. Summarizing where the candidates stand on the issue, AP cited Donald Trump’s wall along our southern border, which he contends is essential to stopping the flow of illegal drugs into the country, and Hillary Clinton’s pledge to spend ten billion dollars on addiction services.

1st October 2016
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