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The Rosenthal Report - March 2017

Rosenthal Reports


Can the Feds Delegalize Marijuana—and Should They?

Yes, they can, but not easily. So it came as something of a surprise last month when White House press secretary Sean Spicer was asked about the federal ban on pot and told reporters “I do believe you’ll see greater enforcement of it.” Not for medical use, he explained “That’s very different than the recreational use, which is what the Department of Justice will be further looking into.”

Recreational use, now legal in eight states, has achieved quasi legitimacy under the past three presidents. An Obama administration memo agreed not to challenge state marijuana laws so long as the drug did not cross state lines, reach children, or benefit drug cartels. Although a federal crackdown on marijuana would appear to be inconsistent with the Trump administration’s embrace of states’ rights, Attorney General Jeff Sessions has long been an opponent of legalized pot and declared during his confirmation hearing “I won’t commit to never enforcing federal law.”

There’s a case to be made for the status quo, and it has been made by Washington’s Governor Jay Inslee and Attorney General Bob Ferguson who wrote to Sessions earlier in the month, arguing that Washington State’s tightly regulated, tax paying marijuana industry was plainly preferable to illegal trafficking that enriched criminals.  Inslee and Ferguson are prepared to take the issue to court. (They’ve won against the new administration twice already.)  But, while there are state sovereignty claims they can raise and officials in other states consider any administration action now “federal overreach” most lawyers would agree that the federal supremacy clause of the Constitution trumps all and state laws must defer to federal.

And that’s for the best. Despite the benefits of legalization (and there are some), the downside can be grim indeed. In Washington, the state’s Traffic Safety Commission found the number of DUI arrestees testing positive for THC rose from 19 percent to 33 percent in the two-and-a-half years since legalization in 2012, and the number of traffic fatalities involving marijuana rose 48 percent between 2013 and 2014.  In Colorado, marijuana use among both adolescents and adults has steadily increased since legalization stretching well beyond the national average. 

Kevin Sabet, who heads Smart Approaches to Marijuana (SAM) welcomes federal intervention “The current situation is unsustainable,” he says. “States that have legalized marijuana continue to see a black market for the drug, increased rates of youth drug use, continued high rates of alcohol sales, and interstate trafficking, with drug dealers taking advantage of non-enforcement.” 

Bear in mind that marijuana, particularly the high-test products of today, are far from the relatively benign substance that aging baby boomers recall from their youth. Outside the legalized states, teen use has remained relatively stable, while adult use has been rapidly rising. 

What researchers are now finding among adult users are low levels of risk awareness, increased incidence and severity of cannabis use disorder, and higher risk of death and psychosis. Risk of psychosis also exists for adolescent users, along with impaired learning, judgment, and memory. Teens have a greater vulnerability to marijuana addiction, and a new and frightening discovery is the risk to pot-smoking teens of lasting harm to the brain.  
All things considered, a federal crackdown on state legalized recreational marijuana may not be a bad idea. 

 

Drugs and the Elderly

Rising Number of Seniors Now Use Three or More Psychoactive Drugs
Popping “a pill for every ill” has become the American way. Encouraged by the pharmaceutical industry, we have abiding faith in medication to keep us comfortable and content, especially as our minds and bodies age and we face the multiple infirmities of our later years. So it is alarming but not surprising that researchers at the University of Michigan found the number of seniors using three or more mind or mood altering drugs have more than doubled over the past decade.  Data collected by the Center for Disease Control showed there were 3.38 million doctor visits in 2013 by patients over 65 taking three or more psychoactive drugs—up from 1.5 million such patients in 2004.  The sharpest increase was in rural areas where the number of these patients tripled.

Nearly half the heavy consumers of psychoactive drugs found by the study had no formal diagnosis of a mental health disorder, insomnia, or chronic pain, the three conditions for which most of these drugs—antidepressants, painkillers, tranquilizers, and sleeping pills—are usually prescribed. One quarter of the prescriptions were for antidepressants and 10 percent for opioids.  Among patients with ongoing prescriptions for a benzodiazepine tranquilizer, only 16 percent had a diagnosed mental health condition and almost none was referred for behavior therapy.
Mixing mind-altering substances poses considerable risks for seniors. Dizziness and confusion are common side effects and make falling a major concern, while the combination of opioid painkillers and benzodiazepine tranquilizers can prove fatal. 

Medical Marijuana for the Retired: Benefit or Hazard?
More and more, seniors are turning to marijuana to relieve a host of ailments, including neuropathic pain, arthritis, the muscle spasms of multiple sclerosis, and the appetite loss and nausea of chemotherapy. A report in the New York Times noted that much of this consumption takes place in nursing homes and retirement communities. Although most nursing homes do not openly allow it, an increasing number are developing programs to regulate how residents in the 29 states that sanction medical marijuana can take their daily dose.  

Professional opinion is divided. A number of academic researchers see medical use by elders as an important and growing field of study. Others, including Dr. Thomas Strouse at UCLA, view medical marijuana for the aged with alarm. “There’s no evidence that it is particularly helpful to older people”, he says, and points to the possible harm of older marijuana users becoming dizzy, confused, and more likely to fall. 

 

Drug Firm Accused of Price Gouging for Opioid Overdose Injector

As the nation’s opioid epidemic continues to spiral, Kaleo Pharma is under fire for dramatically raising the price of its popular injector device that delivers the opioid overdose-reversing drug naloxone. Kaleo hiked the price to $4,500 for a twin pack of the Evzio device, which cost $690 when it was introduced in 2014. This increase of more than 500 percent prompted more than 30 U.S. senators to ask Kaleo for an explanation. 

The firm maintains the list price issue is largely “moot” because Kaleo gives away many devices, insurance covers the cost for many patients, and the Veterans Administration has negotiated a lower price. But it’s clear that if you can’t pay, the price surge hurts. For example, Vermont’s health department says Evzio isn’t an option due to its high cost, so the state’s first responders will use a less expensive nasal spray that might not prove as effective. 
 First responders prefer Evzio because it comes in pre-filled dosages and provides a unique “intelligent system” with voice and visual guidance to help administer the drug. The rate of opioid overdoses is accelerating.  Over a span of just 32 hours in early February, emergency workers in Louisville, Kentucky reportedly responded to almost two overdose cases an hour. Facing this kind of pressure, devices like Evzio can be critical to saving lives.  But Kalẻo’s sky-high prices may put them out of reach for many healthcare providers struggling to contain a worsening crisis.

Marijuana Update

Warnings about Using Pot for Children with Autism 
Doctors at Boston’s Children’s Hospital and the Department of Pediatrics at Harvard University Medical School strongly advise against using marijuana to treat children and adolescents with marijuana, autism, ADHD or other developmental and behavioral disorders. Although this practice is being advanced by some parent advocacy groups, the doctors clearly state that “good evidence is almost entirely lacking” to support it.  The doctors voice concern that efforts to use pot for this purpose, coupled with the push to legalize medical marijuana, may result in medical marijuana permits being issued for developmental and behavioral conditions “for which no data on efficacy, safety or tolerability exist.”

Marijuana Treatment for Veterans Linked to Suicide
New doubts have been raised about pot-based treatments for veterans with PTSD.  A report in the Journal of Psychiatric Research cited evidence that marijuana-dependent military veterans face an increased risk of suicidal thoughts and suicide attempts, not a diminished one. The study looked at more than 3,000 veterans of the Afghanistan and Iraq wars, many of whom have turned to pot to treat symptoms of PTSD.  Concerned about a suicide rate among these veterans of nearly 20 a day, the authors call for further study of the relationship between cannabis use disorder (CUD) and suicidal ideation among men and women who served in those wars.    

3rd March 2017
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Republican healthcare proposal to replace Obamacare could threaten Medicaid-related mental health and substance abuse treatment programs!

Rosenthal Reports

In its current form, GOP plan would fundamentally change Medicaid funding for 74 million low income Americans: one-third of those on Medicaid rolls receive treatment for a mental health of substance abuse disorder.

As the opioid crisis deepens and devastates families and communities, Congress must stand up for vulnerable patients and not jeopardize funding to states and patients who need drug programs!

1st March 2017
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Tell the President:

Other

DON’T dump the Drug Czar

DO save the ONDCP

Drug overdose kills more than 52,000 Americans a year—more than cancer, more than auto accidents.
A cohesive national anti-addiction policy is essential.
But the Office of Drug Control Policy (ONDCP), the part of your White House that oversees 
the nation’s anti-drug efforts, is on the hit list of the Budget Office, along with PBS, Americorps, and the National Endowments.
Eliminating ONDCP will save roughly $25 million for salaries, expenses, and policy research, and denyabout $350 million to critical drug control programs.
This is penny wisdom and pound folly at its worst.

-Mitchell S. Rosenthal, MD
President

 

1st March 2017
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You are making a difference in the lives of children and families who are struggling with drugs. Every donation matters.

- Dr. Mitch S. Rosenthal

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