Even under the best circumstances, however, addiction is a disease prone to relapse. An estimated 40-60% of people who misuse drugs will return to using them at some point during recovery—and it’s this time that leaves them most vulnerable to overdose, since their tolerance has dropped, often dramatically, during their period of abstinence.The US covid pandemic has a sinister shadow—drug overdoses — BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4751 (Published 17 December 2020)
Attention-deficit/hyperactivity disorder (ADHD) exerts lifelong impairment, including difficulty sustaining employment, poor credit, and suicide risk. To date, however, studies have assessed selected samples, often via self-report. Using mental health data from the entire Swedish population (N = 11.55 million) and a random sample of credit data (N = 189,267), we provide the first study of objective financial outcomes among adults with ADHD, including associations with suicide. Controlling for psychiatric comorbidities, substance use, education, and income, those with ADHD start adulthood with normal credit demand and default rates. However, in middle age, their default rates grow exponentially, yielding poor credit scores and diminished credit access despite high demand. Sympathomimetic prescriptions are unassociated with improved financial behaviors. Last, financial distress is associated with fourfold higher risk of suicide among those with ADHD. For men but not women with ADHD who suicide, outstanding debt increases in the 3 years prior. No such pattern exists for others who suicide.Science Advances
30 Sep 2020:
Vol. 6, no. 40, eaba1551
DOI: 10.1126/sciadv.aba1551 — https://advances.sciencemag.org/content/6/40/eaba1551
Here in the US we’ve seen an steady increase in ADHD diagnoses.
And an alarming increase in suicide.
Then my mind wanders to drugs (to drugs, not due to drugs).
To summarize, the psychiatric side effects of methylphenidate are quite similar to those of cocaine and amphetamines, giving more support to the idea that almost all CNS stimulants will produce a similar clinical picture. A person using cocaine can experience nervousness,57,58 restlessness,58 agitation,57 suspiciousness,60 paranoia,61–63 hallucinations and delusions,61,63 impaired cognitive functions,64 delirium,65 violence,57,58,62,65,66 suicide,67 and homicide.67–70Methylphenidate Abuse and Psychiatric Side Effects — http://Prim Care Companion J Clin Psychiatry. 2000 Oct; 2(5): 159–164. doi: 10.4088/pcc.v02n0502
I just hope I’m wrong.
The rate of drug overdose deaths involving cocaine was stable between 2009 and 2013, then nearly tripled from 1.6 per 100,000 in 2013 to 4.5 in 2018.NCHS Data Brief No. 384, October 2020 — https://www.cdc.gov/nchs/products/databriefs/db384.htm
Memo to all of my friends in the mortality risk business:
With so much attention being paid to Covid-19 it’s easy to forget people die from other causes. Don’t forget this.
According to Ginger, an organization that provides mental health services to companies, compared to January and February of this year, prescriptions for psychotropics, most of which were antidepressants, were up 86% for the months of March and April.
The stress of unemployment, social isolation and health concerns are all cited by Americans who say the lock down is having a serious impact on their mental health.
Pharmacy group Express Scripts also revealed that prescriptions for anti-anxiety medications were up 34.1% between mid-February and mid-March, while prescriptions for antidepressants increased 18.6%.
Previous research by Humphreys and colleagues showed that people who used medical cannabis also had higher rates of opioid use and misuse. “This is one of many examples where claims about the benefits of medical cannabis are not supported by evidence,” Humphreys told MedPage Today. The current study had several limitations: it relied on cross-sectional, self-reported data and was subject to possible selection bias and confounding. It also did not assess the frequency or quantity of cannabis or opioid use, or the type of chronic pain.
Among veterans enrolled in VA and Part D, dual use of opioid prescriptions was independently associated with death from prescription opioid overdose. This risk factor for fatal overdose among veterans underscores the importance of care coordination across health care systems to improve opioid prescribing safety.
Full abstract at this link.
A study of more than 1,200 luxury real estate purchases in B.C.’s Lower Mainland in 2016 found that more than 10 per cent were tied to buyers with criminal records. Continue reading →
A new study confirms that cannabis use is related to impaired and lasting effects on adolescent cognitive development.
To understand the relationship between alcohol, cannabis use and cognitive development among adolescents at all levels of consumption (abstinent, occasional consumer or high consumer), the research team followed a sample of 3,826 Canadian adolescents over a period of four years. Using a developmentally sensitive design, the authors investigated relationships between year-to-year changes in substance use and cognitive development across a number of cognitive domains, such as recall memory, perceptual reasoning, inhibition and working memory. Multi-level regression models were used to simultaneously test vulnerability and concurrent and lasting effects on each cognitive domain. The study found that vulnerability to cannabis and alcohol use in adolescence was associated with generally lower performance on all cognitive domains.
Yikes. Read the full story here.
As a psychiatrist, I have encountered countless individuals in the emergency room who come through and do not want help. “What K2? I don’t use that stuff.” They will deny it, laugh it off, or scoff at me. They threaten to commit suicide if I don’t let them stay the night, and demand extra sandwiches and clothes. These individuals have the ability to decipher their options. If the person’s thinking suddenly clears and there is no sign of physical instability, he or she can just walk out the emergency room almost minutes after presenting. In the dead of night, I’ve had unconscious patients who wake up abruptly only to demand to leave. I have no choice but to discharge them “home” to no particular address, since none are listed.
Here’s the link to the full article.
Public-health experts worry about the increasingly potent options available, and the striking number of constant users. “Cannabis is potentially a real public-health problem,” said Mark A. R. Kleiman, a professor of public policy at New York University. “It wasn’t obvious to me 25 years ago, when 9 percent of self-reported cannabis users over the last month reported daily or near-daily use. I always was prepared to say, ‘No, it’s not a very abusable drug. Nine percent of anybody will do something stupid.’ But that number is now [something like] 40 percent.” They argue that state and local governments are setting up legal regimes without sufficient public-health protection, with some even warning that the country is replacing one form of reefer madness with another, careening from treating cannabis as if it were as dangerous as heroin to treating it as if it were as benign as kombucha.
But cannabis is not benign, even if it is relatively benign, compared with alcohol, opiates, and cigarettes, among other substances. Thousands of Americans are finding their own use problematic in a climate where pot products are getting more potent, more socially acceptable to use, and yet easier to come by, not that it was particularly hard before.
Read the entire Atlantic article here.
A new study in the journal Addiction finds that, after legalization, the use of marijuana among students at an Oregon college increased relative to that of students in states where the drug is still illegal. But, in a twist, the rise was mainly seen among those students who had also reported drinking heavily recently. The Oregon students who binge drank were 73 percent more likely to also report using marijuana, compared to binge-drinking students in states that didn’t legalize marijuana.
Interestingly, though, this study does suggest that legal marijuana, at least among college kids, does not seem to have much of a substitution effect. Contrary to the predictions of some legalization enthusiasts, teens don’t seem to be foregoing binge drinking—arguably a more physically harmful practice—in order to smoke weed. Instead, they’re doing both.
Read another Atlantic article on the topic here.
Binge drinking AND smoking pot. A fine combination.