November 20, 2015

Experts: Merger of World’s Two Largest Beer Manufacturers is Global Health Threat

The impending merger of the world’s two largest beer manufacturers represents a global health threat, experts warned this week. They said the merger could worsen the growing epidemic of alcohol-related harm in low- and middle-income countries.

Last month, Belgium-based Anheuser-Busch InBev and London-based SAB Miller announced they have agreed in principal to merge, MedicalXpress reports. The new company will produce an estimated one-third of all beer sold worldwide, Professor Jeff Collin and colleagues at the University of Edinburgh wrote in The BMJ.

The companies hope to expand in developing nations, with a particular emphasis on Africa as “a critical driver of growth for the combined company,” the researchers noted.

“The health implications of this forecast are disturbing: market growth on this scale is predicated on exploiting Africa’s low per capita consumption of beer, targeting low-income consumers to drive increased sales,” Collin and colleagues wrote. The merged companies’ plan “echoes that of transnational tobacco companies, with which the alcohol industry shares strategic similarities and has close corporate links as well as comparable health effects,” they added.

They noted that the global alcohol industry “continues to occupy an ambiguous space in which an indirect acknowledgement of serious health effects coexists with the prospect of partnerships and shared objectives.”

They urge the public health community to “do more to ensure that conflict of interest with alcohol companies is recognized and addressed.”

November 16, 2015

Alcohol Compliance Sales Checks-- Fall 2015

The high school football season brings memorable events for young people including homecoming games and related dances and parties. Unfortunately, with these events also come concerns about underage drinking.

Throughout the homecoming season, businesses throughout Lake County saw teens entering their stores attempting to purchase alcohol. This was part of a county-wide effort to continue promoting positive practices by stores and restaurants that sell alcohol. Law enforcement agencies worked with local groups and young adults to see if they could purchase alcohol with identification that showed they were under 21.

“Consistency from community to community and monitoring underage drinking issues will help us be successful in addressing this problem and saving lives. Our desire is to see 100% compliance, but it is refreshing to see the majority of businesses realize the seriousness of this issue and did not sell alcohol to the underage participants.” commented Bruce Johnson, Chairman of the Lake County Underage Drinking and Drug Prevention Task Force.

Departments that participated in the recent compliance checks include: 

   Community                  Checks           Violations
Buffalo Grove 18 1
Deerfield 10 2
Grayslake Hainesville  12 0
Gurnee 41 2
Highland Park 11 4
Kildeer 5 1
Lake Forest 16 0
Lake Zurich 19 2
Lincolnshire 18 2
Mundelein 13 0
Riverwoods 3 2
Vernon Hills 47 2
Total 213 18
Failure Rate 8.5%

Sale of alcohol to a person under 21 years of age is illegal under local and State laws and is a Class A misdemeanor punishable by up to a year in jail, fine or probation.

Liquor compliance checks are part of an initiative by the Lake County Underage Drinking and Drug Prevention Task Force which was formed to combine the efforts of the Lake County Chiefs of Police Association and the Lake County After School Coalition in the prevention of underage consumption of alcohol. This group is made up of a diverse group of citizens including community members, parents, law enforcement personnel and other professionals interested in preventing underage drinking.

November 2, 2015

60 Minutes: Heroin in the Heartland

October 26, 2015

Study Finds the Prevalence of Marijuana Use Among U.S. Adults Doubled Over Past Decade

The percentage of Americans who reported using marijuana in the past year more than doubled between 2001-2002 and 2012-2013, and the increase in marijuana use disorder during that time was nearly as large. Past year marijuana use rose from 4.1 percent to 9.5 percent of the U.S. adult population, while the prevalence of marijuana use disorder rose from 1.5 percent to 2.9 percent, according to national surveys conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

“Based on the results of our surveys, marijuana use in the United States has risen rapidly over the past decade, with about 3 in 10 people who use marijuana meeting the criteria for addiction. Given these increases, it is important that the scientific community convey information to the public about the potential harms,” said George Koob, Ph.D., director of NIAAA, in a news release.

Data about marijuana use was collected as part of NIAAA’s National Epidemiologic Survey on Alcohol and Related Conditions, a series of the largest epidemiological surveys of their kind. In total, 79,000 people were interviewed on alcohol use, drug use and related psychiatric conditions during the 2001-2002 and 2012-2013 surveys.

This analysis appears in this week’s issue of the Journal of the American Medical Association (JAMA) Psychiatry.

The marked increase in marijuana use and marijuana use disorder shown in the study is a significant change from prior results. Earlier NIAAA research found that marijuana use remained stable at about 4 percent of the U.S. population between 1991-1992 and 2001-2002, while abuse and dependence rose from 1.2 percent to 1.5 percent.

Based on the current study, approximately 30 percent of people who used marijuana in the past year met criteria for marijuana use disorder during 2012-2013, as defined by the Diagnostic and Statistical Manual of Mental Disorders. This includes symptoms such as taking the drug in larger amounts or over a longer period than was intended by the user; the persistent desire to cut down or control use/unsuccessful efforts to do so; failure to fulfill major role obligations at work, school or home as a result of marijuana use; and tolerance and/or withdrawal.

“These findings highlight the changing cultural norms related to marijuana use, which could bring additional public health challenges related to addiction, drugged driving and access to effective treatment,” said Nora D. Volkow, M.D., director of the National Institute on Drug Abuse (NIDA), which contributed funding to the study, also in a news release. “NIDA will continue to work with our partners at NIAAA and across the federal government to educate the public and policymakers on these and other issues related to the use of psychoactive drugs.”

The near doubling of the prevalence of marijuana use disorder among the U.S. population in the last decade can be attributed to the substantial increase in marijuana use overall, rather than an increase in rates of addiction among users. The proportion of users who have a marijuana use disorder was found to have actually decreased (35.6 percent to 30.6 percent) between 2001-2002 and 2012-2013. Symptoms of marijuana use disorder were assessed during face-to-face interviews.

When examined by age, young adults (ages 18 – 29) were found to be at highest risk for marijuana use and marijuana use disorder, with use increasing from 10.5 percent to 21.2 percent and disorder increasing from 4.4 percent to 7.5 percent over the past decade. Black and Hispanic individuals also showed especially noticeable increases in the prevalence of marijuana use and marijuana use disorder, with use increasing from 4.7 percent to 12.7 percent over the past decade among blacks and from 3.3 percent to 8.4 percent among Hispanics. The prevalence of marijuana use disorder increased from 1.8 percent to 4.6 percent among blacks and 1.2 percent to 2.8 percent among Hispanics over the same time period. All increases were found to be statistically significant.

Twenty-three states now have medical marijuana laws and four states, as well as the District of Columbia, have legalized marijuana for recreational use. Studies funded by NIDA and NIAAA have shown that marijuana impairs driving performance, increasing lane weaving, and that since the legalization of medical marijuana in Colorado, drivers involved in fatal motor vehicle crashes are significantly more likely to test positive for marijuana use. With changes in the drug’s legal status at the state level and a shift in beliefs about the risks associated with its use, the study authors note that public education about the dangers associated with marijuana use, presented in a reasonable and balanced manner, will be increasingly important to counteract public beliefs that marijuana use is harmless.

As marijuana and alcohol are frequently used together, more research is also needed to understand the effects of combined use. Studies suggest that using marijuana and alcohol together impairs driving more than either substance alone and that alcohol use may increase the absorption of THC, the psychoactive chemical found in marijuana.

October 7, 2015

E-Cigarettes Being Used to Vaporize Marijuana

E-cigarettes are being used by more people to smoke marijuana or synthetic drugs, CNNreports. People use the devices to get high without police, parents or teachers knowing.

E-cigarette devices, known as vape pens, are showing up in a growing number of drug busts, according to CNN. It is almost impossible to tell whether a person is using them to smoke nicotine, marijuana concentrate or synthetic drugs such as K2 or Spice.

“It’s the concealment method; we don’t know what is in a vape pen until we actually have it tested by a forensic laboratory,” said Supervisory Special Agent John Scherbenske of the U.S. Drug Enforcement Administration.

According to Reuters, a new study finds almost 20 percent of high school students who said they used e-cigarettes for nicotine also used them to vaporize marijuana. The study of almost 4,000 teens appears in the journal Pediatrics.

“Forms of cannabis that can be vaporized, like hash oil, can be many times stronger than marijuana that is smoked,” lead researcher Meghan Morean of Oberlin College in Ohio told Reuters. She found that of students who had used e-cigarettes, 18 percent used them to vaporize cannabis in some form, including hash use and wax infused with THC, the main psychoactive ingredient in marijuana.

The study found students were 27 times more likely to use e-cigarettes to vaporize cannabis than adult e-cigarette users.

October 6, 2015

Commentary: Revisiting the Impact of Marijuana Legalization on Children

In December 2011, Join Together published a commentary entitled “Legalization of Marijuana and the Impact on Children.” The article stressed that future laws legalizing marijuana use should have strict provisions designed to prevent underage consumption. In the intervening 44 months, four states plus the District of Columbia have legalized the personal use and possession of small amounts of marijuana,[1] the number of states allowing the medicinal use of marijuana for debilitating medical conditions has increased from 16 to 24[2] and 18 states now allow the limited use of low-tetrahydrocannabinol (“THC”) products to treat seizure disorders.[3] Given all this legislative focus on marijuana laws, are we now at a point where we can determine the impact of marijuana legalization on children?

Well, yes and no. In the sense that there is a growing body of scientific evidence, increased research and more recent data, yes. In the sense that the studies are providing clear answers, no.

At least there is some positive news. Two recent studies published earlier this summer using data from the Monitoring the Future program (MTF) suggest that the expansion of marijuana laws has not resulted in increased usage by teenagers.[4] In particular, these studies conclude that:
  • in the states that legalized the medicinal use of marijuana before 2014, there was no statistically significant change in teens’ (age 13-18) use of marijuana after the law was passed;[5] and
  • when comparing data from 2002 and 2013, the proportion of younger adolescents (age 12-14) strongly disapproving of marijuana use has increased slightly, while the percentage of teens (both ages 12-14 and 15-17) who have used marijuana in the past 12 months has decreased slightly.[6]
And, when looking at the published MTF data, it appears that the students’ perception of the ease with which they can get marijuana has not changed substantially in recent years (if anything it has lowered) and remains lower than the high water mark in the late 1990s.[7]

There are areas of concern in these and other recent studies, however. The same researchers noted above report that:
  • although changes in the law did not alter usage, teen use of marijuana is higher in the states that have legalized the medicinal use of marijuana than in other states, suggesting that the usage rate is a product of “state-level” factors that warrant additional study;[8] and
  • the percentage of adults aged 18-25 who strongly disapprove of marijuana use has dropped significantly in recent years.[9]
Moreover, in data gathered during 2010 and 2011, California students in grades six through eight who had seen marijuana advertising reported that they were twice as likely to use marijuana (or consider using it) than those who had not seen the advertising.[10] Furthermore, since 2000, the number of calls made to U.S. poison control centers concerning marijuana ingestion by children under age six has increased generally, with particular increases in the states that legalized the medicinal use of marijuana during that time.[11]

Although the available research may not yet provide clear answers, lawmakers do seem to be taking heed of concerns about underage access and non-authorized use of marijuana. For example:
only one state that legalized the medicinal use of marijuana after December 2011 allows any form of home cultivation, instead requiring patients to obtain marijuana at state-licensed cultivators/dispensaries;[12]
  • more recent laws and regulations allowing the medicinal use of marijuana often limit the number of cultivators/dispensaries that will be allowed, sometimes require licensed pharmacists to be involved with dispensaries and routinely place stringent restrictions on who can enter dispensaries and on the packing/labeling/testing of marijuana;
  • Louisiana, Minnesota and New York exclude smoking from the list of allowable methods to use marijuana medicinally; and
  • within the past six months, Oregon and Washington have tightened up their regulations concerning the medicinal use of marijuana.
Unfortunately, there is not yet sufficient data from Washington and Colorado to support large scale studies of the impact of legalizing the personal use of marijuana on children in those states. However, once that data develops and researchers have more time to look at it and pre- and post-law change data in all states, it will be important to revisit this question.

by Jon Woodruff, Legislative Attorney, National Alliance for Model State Drug Laws

[1] Alaska, Colorado, Oregon and Washington.

[2] The eight states who have passed laws since December 2011 are: Connecticut, Illinois, Louisiana, Maryland, Massachusetts, Minnesota, New Hampshire and New York.

[3] Alabama, Delaware, Florida, Georgia, Iowa, Kentucky, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah, Virginia, Wisconsin and Wyoming.

[4] “Monitoring the Future” is an ongoing study of U.S. 8th, 10th and 12th graders’ behaviors, attitudes and values on a variety of topics, including illicit drug The program started collecting data from 12th graders in 1975 and data from 8th and 10th graders in 1991. The latest year of data available is 2014.

[5] Hasin DR, Wall M, Keyes KM, et al. Medical marijuana laws and adolescent marijuana use in the USA from 1991 to 2014: results from annual, repeated cross-sectional surveys. Lancet Psychiatry 2015; 2: 601–08.

[6] Salas-Wright CP, Vaughn MG, Todic J, Cordova D, Perron BE. Trends in the disapproval and use of marijuana among adolescents and young adults in the United States: 2002–2013.The American Journal of Drug and Alcohol Abuse (posted online July 9, 2015)

[7] See Johnson LD, O’Malley PM, Miech RA, Bachman JG, Schulenberg JE. Monitoring the Future National Survey Results on Drug Abuse 1975-2014: 2014

[8] Hasin DR, Wall M, Keyes KM, et al.

[9] Salas-Wright CP, Vaughn MG, Todic J, Cordova D, Perron BE.

[10] D’Amico, EJ, Miles JNV, Tucker, JS. Gateway to Curiosity: Medical Marijuana Ads and Intention and Use During Middle School. Psychology of Addictive Behaviors June 1, 2015.

[11] Onders B, Casavant MJ, Spiller HA, Chounthirath T, Smith GA. Marijuana Exposure Among Children Younger Than Six Years in the United States. Clinical Pediatrics June 7, 2015. Thankfully, the total volume of calls remains low, with fewer than 2,000 calls total over the 14-year period.

[12] The state is Massachusetts, and a patient is allowed to cultivate marijuana at home only if the overseeing state agency is satisfied that the patient faces hardship in accessing a dispensary.

October 5, 2015

Baltimore Sun Editorial on Opioid Misuse

The statistics are sobering. Last year, nearly 900 Marylanders died from opioid misuse, including 578 from heroin alone, which means that opioid deaths account for more than 85 percent of all intoxication deaths throughout the state. And the problem is worsening; the 2014 data represent a 22 percent increase from the previous year and a 76 percent increase since 2010.

Opioids are painkillers, like morphine and others, and the stories of the pain they cause are saddening. Heroin and opioid misuse touches every county, city, town and subdivision in Maryland. It knows no racial, economic, age or gender boundaries.

It even attacks babies still in the womb. A powerful piece in The Washington Post this summer chronicled the trials of Makenzee Kennedy, an infant who spent the first months of her life in Maryland's Mount Washington Pediatric Hospital, where she battled to overcome a heroin addiction that had been passed on in utero. Data suggest that the incidence of cases like Makenzee's — "neonatal abstinence syndrome" — have quadrupled over the past decade.

It's time to take a stand.

Stemming the tide of opioid misuse demands action from all who touch the lives of those affected by this disease — law enforcement professionals, legislators, health care providers, long-term addiction rehabilitation specialists, behavioral health experts and friends and families.

Maryland's hospitals and physicians are on the front lines of this battle and have already begun work to reduce the chances of heroin addiction. According to the Centers for Disease Control and Prevention, 45 percent of people who use heroin are also addicted to prescription opioids.

That's why the Maryland Hospital Association, working with the Maryland Chapter of the American College of Emergency Physicians, has developed opioid prescribing guidelines to be used in emergency departments in Maryland. The guidelines, embraced by Maryland's acute care hospitals and their emergency department physicians, were crafted to allow doctors the flexibility to prescribe opioids when medically necessary while encouraging practices that can reduce the risk of opioid addiction. The guidelines promote:
  • Screening and patient education to help detect and treat conditions that can lead to misuse and safeguard patients against the development of those conditions;
  • Using existing tools like the state's electronic health information exchange and prescription drug monitoring program to allow health care providers to more effectively track potential misuse of opioids, and
  • Standardizing prescribing practices to reduce unnecessary prescriptions (and the number of pills prescribed) to diminish misuse of opioids.
These and other efforts to standardize and improve opioid prescribing in emergency departments are just pieces of a complex social and medical puzzle, and hospitals and physicians welcome the opportunity to work with other stakeholders to address this dangerous and immediate threat. In six months, the Maryland Hospital Association and the Maryland Chapter of the American College of Emergency Physicians will convene emergency medicine leaders to take a hard look at the guidelines' effectiveness.

Gov. Larry Hogan's administration, as well as several key legislative leaders, deserve great credit for shining a spotlight on this problem and for their commitment to developing means to tackle it. Earlier this year, Governor Hogan and Lt. Gov. Boyd Rutherford created the statewide Heroin and Opioid Emergency Task Force. The task force has now identified a series of recommendations, including the prescribing guidelines now being used in hospital emergency departments, which collectively take aim at Maryland's opioid epidemic and form a framework for further consideration and action by the administration and General Assembly.

While it will take time, dedication and vigilance to chip away at this pervasive problem, hospitals and physicians are attacking the challenge on the front lines of care.