Pot-smoking young adults aren't doomed to psychosis just yet

Early, and then continued, use of marijuana does seem to be associated with an increased risk of psychosis and hallucinations, but allow us to quell some incipient panic.

Caveats, after all, are our specialty.

Previous studies had found a link (not necessarily a cause or effect) between cannabis use and psychosis. So researchers in Queensland, Australia, decided to investigate further and have now established what they consider a fairly strong connection between the length of marijuana use and the likelihood of psychosis in young adults.

The researchers even checked out pot use and psychosis symptoms among siblings just to make sure they haven't been missing some genetic or environmental factor. They don't seem to have been.

So pot use may well play some kind of role in what the researchers term "psychosis-related outcomes."

But, the researchers write in their conclusion: “The nature of the relationship between psychosis and cannabis use is by no means simple."

As they point out: "Those individuals who were vulnerable to psychosis (i.e., those who had isolated psychotic symptoms) were more likely to commence cannabis use, which could then subsequently contribute to an increased risk of conversion to a nonaffective psychotic disorder. In addition, analyses that incorporated adjustments for depressive and anxiety-related disorders led to a reduction in the strength of the association between cannabis use and psychosis-related outcomes. This suggests that depression and/or anxiety disorders may mediate or moderate the pathways between cannabis use and psychosis-related outcomes. We plan to further explore these issues in more detail in future studies."

This is fascinating and provocative stuff, especially as it pertains to young adults' still-developing brains. But the key word from the first paragraph is "associated."

So as for these headlines? "Long-term cannabis use can double risk of psychosis," "Study finds cannabis use is 'crazy-making'," "Teen pot smokers at high risk of mental illness," "Marijuana smoking teens prone to schizophrenia"... Perhaps some panic-quelling is in order.

Here's the full study, published online Monday in the Archives of General Psychiatry.

For a different look at marijuana, here's a recent L.A. Times story: UC studies find promise in medical marijuana

(Not cures, just promise.)

-- Tami Dennis

Credit: Daniel Karmann / EPA

Alcohol use lower among blacks

African Americans have lower drinking rates than other racial groups, according to a new survey from the Substance Abuse and Mental Health Services Administration. It found that blacks ages 18 and older use alcohol at a rate of 44.3% compared with the national average of 55.2%

Moreover, blacks ages 18 to 25 are much less likely than other young adults to engage in binge drinking -- 25.3% compared with 41.6% in the general population.

The survey is part of a series conducted by SAMHSA to learn how to target alcohol and drug abuse treatment and prevention efforts to various age, gender and ethnic groups. The survey also found that the rate of illegal drug use among black adults is higher than the national average -- 9.5% compared with 7.9%. And among black males ages 26 to 49, illegal drug use is 14.7% compared with  11.2% in the general population for that age group. Binge drinking is also much higher in pregnant black women than among pregnant women in other age groups. 

The report is available at the SAMHSA website.

-- Shari Roan

Photo credit: Vince Compagnone  / Los Angeles Times

Detachable needles on syringes promote hepatitis C transmission, study says

The high incidence of hepatitis C infections among drug abusers may be due in part to the use of syringes with detachable needles, which are more likely to transfer viable viruses from one user to the next, Yale University researchers will report Friday. Their study is reputed to be the first that examines the survival of the virus in used syringes.

Dr. Elijah Paintsil of the Yale School of Medicine and his colleagues studied survival of the hepatitis C virus in several types of syringes. They loaded the syringes with blood spiked with the virus, depressed the plunger and measured the concentration of hepatitis C virus in the residual blood immediately afterward and nine weeks later.

Paintsil will report in San Francisco at the 17th Conference on Retroviruses and Opportunistic Infections that the virus persisted for nine weeks at most temperatures in so-called tuberculin syringes with detachable needles. The researchers observed far less viable virus in insulin syringes with attached needles.

The detachable-needle syringes are used much more commonly by drug abusers outside the United States, but Paintsil cautioned that communities operating needle-exchange programs should be aware of the problems with the tuberculin syringes.

-- Thomas H. Maugh II

Photo credit: Adam Gault / Getty Images

Be careful which Maalox you pick up, FDA says

The packages say Maalox Advanced and Maalox Total Relief, and consumers might justifiably think that they are simply two versions of the same product. But they are not, and mix-ups have resulted in at least five reports of serious adverse reactions, the Food and Drug Administration said Wednesday. The drugs' manufacturer, Novartis Consumer Health Inc., has agreed to change the name and labeling of one of the products to minimize confusion, but that probably will not happen until September. Meanwhile, the FDA is cautioning consumers to be very careful when purchasing the over-the-counter products.

Maalox Advanced Regular Strength and Maalox Advanced Maximum Strength are antacids containing aluminum hydroxide and magnesium hydroxide, which neutralize acid in the stomach. Maalox Total Relief is an upset stomach reliever and anti-diarrhea medicine whose principal ingredient is bismuth subsalicylate, which is related to aspirin. Like aspirin, it can cause stomach bleeding. It should not be used by individuals with a history of gastrointestinal ulcer disease or a bleeding disorder, nor by children or teens recovering from a viral infection. It is also counter-indicated for patients taking oral anti-diabetic drugs, blood-thinning drugs and nonsteroidal anti-inflammatory drugs.

The FDA did not say what the adverse reactions were and Novartis has not said what the new name for Maalox Total Relief will be.

-- Thomas H. Maugh II

Image credit: FDA

FDA chastises drug companies for eyebrow-raising claims

Every so often, the FDA has to slap the wrists of drug companies for … well, pretty much everything. On the naughty list this week were several companies that the FDA didn’t feel presented the whole truth and nothing but the truth. Among them:

- Cephalon received a nasty note for not including risks of taking cancer drug Treanda on its dosing card. According to the FDA letter, these risks include skin reactions, infection and death. 

- Amylin and Eli Lilly were called out for misleading statements about the diabetes medication Byetta.

“On June 10, 2009, the Lilly representative claimed that 94% of patients in a study lost 7 to 8 pounds without diet or exercise in 30 days. On June 11, 2009, an Amylin representative claimed that 80% of patients in a study lost about 7 to 8 pounds over 30 weeks.”

Which one’s right, you ask? Neither, says the FDA. 

 Bayer got smacked down by the FDA for a script that linked the contraceptive Mirena to “looking and feeling great.” The Food and Drug Administration did not take kindly to that, apparently:

FDA is not aware of any evidence suggesting that women who are using Mirena for birth control look great or feel great. Patients using Mirena may experience various side effects, such as irregular bleeding, ovarian cysts, back pain, weight increase, breast pain/tenderness, and acne, in addition to the side effects indicated above.… If you do, in fact, have data to support these claims, you should submit them to FDA for review.

Moral of the story? Take pharmaceutical ads with a grain (or a shaker) of salt. They’re trying to sell you a drug, and the more positive associations your brain makes with that drug, the better for the companies – which is not the same thing as better for you. Always check the warning label. Unbiased drug information can be found at the FDA website, though drugs.com and rxlist.com may provide more user-friendly formats. And, at the risk of sounding like an ad myself, talk to your doctor about what’s right for you.

-- Amina Khan

Photo credit: Wilfredo Lee / Associated Press

New York City criticized for its heroin how-to guide

Oh, New York City -- your heart may have been in the right place when you published a handy step-by-step safety booklet for drug users. But you might want to rethink your tactics. (Another recent case in point: those “drinking fat” ads.)

The Department of Health and Mental Hygiene’s 70,000-copy effort to educate heroin users on reducing infection and risk of overdose is coming under fire from federal drug enforcement agents in New York, according to an Associated Press story.

The state's top official with the Drug Enforcement Administration calls the "Take Charge Take Care" guide a "step-by-step instruction on how to inject a poison." DEA special agent-in-charge John Gilbride says the handout is disturbing. 

The nonjudgmental writing style and yellow cover is indeed reminiscent of the "For Dummies" how-to book series.  

But think of the new guide as a verbal version of by-now-commonplace needle-exchange programs, which recently received symbolic White House support with the removal of a federal ban on funding: If people are going to use drugs, no matter how hard you try to stop them, you may as well make sure they do so safely. It ultimately saves on risks and costs to them and others.

Still, I have to wonder about the city's priorities. The 16-page booklet starts out with 10 tips for safer use. Here's a sampling:

No. 1: Prevent overdose.

No. 4: Use new syringes.

Further down, No. 9: Get help for depression.

And finally -- at the bottom of the list -- No. 10: Ask for help to stop using.

Might have been a good idea, if only for appearances' sake, to switch those around a little.

-- Amina Khan

What doesn't kill you ... probably doesn't do much anyway

Singer Billy Joel's daughter, Alexa Ray Joel, lit up the blogosphere today after reportedly swallowing eight pills of Traumeel, "distraught over the ending of a recent relationship," according to Us Magazine. 

Traumeel, marketed as anti-inflammatory medication, contains a mix of herbs and other ingredients in low doses, and can come as a pill or an ointment.

The 23-year-old, who allegedly called 911 in a panic, needn't have worried -- there's no overwhelming proof that the homeopathic alternative to ibuprofen does much of anything. 

"If it is a homeopathic preparation, that means it is given in very low dose," said Paul Lofholm, a pharmacist based in Marin County. "It’s pretty hard to overdose on any homeopathic drug, because it has such a low potency."

Those of you eyeing your medicine cabinets can breathe easier -- Traumeel probably won't hurt. But it's probably wasting your valuable shelf space.

-- Amina Khan

Cocaine vaccine shows promise

A vaccine to treat cocaine dependence yielded good results in a phase-2 clinical trial and will be tested next year in a larger study, researchers reported today.

The cocaine vaccine is not intended to prevent addiction but instead is designed for use with other treatments, such as behavioral therapy, to assist people in recovery. The vaccine is among a number of research projects relying on similar technology to treat nicotine, heroin and methamphetamine addiction.

Cocaine is comprised of tiny molecules that sneak across the body’s blood-brain barrier before the immune system recognizes the substance as foreign. By attaching cocaine-like molecules to a larger protein, the vaccine circumvents that problem and allows the immune system to recognize the protein and its cargo. If a sufficient level of antibodies is created through repeated vaccine injections, those antibodies will disable the addictive drug before it enters the brain, causes euphoria and triggers the cascade of brain chemicals that lead to drug cravings.

In the current study, researchers enrolled 115 cocaine-dependent people in a 24-week trial. Half of the individuals received five injections of the experimental TA-CD vaccine (which stands for therapy for addiction-cocaine addiction) over 12 weeks while the other half received placebo injections. The participants’ urine was tested three times per week over the course of the study. The vaccine produced a large enough antibody response to reduce cocaine use in 38% of the 55 addicted individuals who received all five injections. There were no serious side effects.

The study is published in the Archives of General Psychiatry.

“The antibodies slow cocaine’s entry into the brain. And because it is slowed down so much, the drug isn’t reinforcing any more,” said Dr. Thomas Kosten, a psychiatrist at Baylor College of Medicine and lead author of the study. "The most promising thing we found is that once we got those cocaine antibody levels up, they were more effective than we thought they were going to be. The part that we did expect, but that was still disappointing, is about 20% of people don't make much of an antibody response."

About 300 cocaine-dependent individuals will be enrolled in a study beginning in January to further test the vaccine, Kosten said. The vaccine approach is intended for use in people who desire to quit using, said Berma M. Kinsey, a research chemist at Baylor who has worked on the vaccine. It is not meant for preventing addictions from forming in the first place or for people who don't want to quit.

"It's for people who are motivated to get off drugs," she said. "It's not a cure-all."

-- Shari Roan

Photo credit: Guillermo Arias  /  AP

Drug testing could stop 'academic doping'

Students taking important exams could one day find themselves in the same position as professional athletes -- submitting to a drug test before the big event. The practice of students taking cognitive-enhancing drugs, such as methylphenidate, has become so common that those who don't "dope" are at an unfair advantage, argues a psychologist writing in the new issue of Journal of Medical Ethics.

Chemically enhanced academic performance is cheating, says Vince Cakic, of the department of psychology at the University of Sydney, Australia. Already, he notes, medications meant to treat attention deficit hyperactivity disorder are used by college students to improve their test scores. And many other cognitive-enhancing medications, which he calls nootropics, are being developed for diseases such as Alzheimer's. While the ADHD drugs improve performance only modestly, future drugs for dementia may make a big difference in an individual's capacity to study and test scores. "The possibility of purchasing 'smartness in a bottle' is likely to have broad appeal to students with normal or above average cognitive functioning to begin with," he wrote

Rules prohibiting the use of performance-enhancing drugs in sports fail unless athletes are subjected to routine urine tests, Cakic says. The same strategy would likely be necessary to prevent cheating in academics. According to his paper, the use of methylphenidate and amphetamines is as high as 25% on some U.S. college campuses. The most academically competitive schools are thought to have the highest usage rates of these drugs. The more students who take the drugs, the more non-cheating student are put at a disadvantage and thus may feel compelled to cheat, too.

"It is apparent that the failures and inconsistencies inherent in anti-doping policy in sport will be mirrored in academia unless a reasonable and realistic approach to the issue of nootropics is adopted," Cakic wrote.

Cheating is not the only worry for college administrators. The rampant use of nootropics may lead to serious health problems in some students who take them without a doctor's approval.

". . . there is a greater need to examine the safety and efficacy of putative nootropics in the healthy rather than only in clinical populations," he wrote. "However, the widespread non-medical use of methylphenidate suggests that students will use nootropics regardless of their safety and legality."

-- Shari Roan

Photo credit: Keith Beaty / Toronto Star / ZUMA Press

Cocaine laced with veterinary drug causing serious illness

A federal agency warned this week that cocaine laced with levamisole, a veterinary anti-parasitic drug, has caused 20 cases of a serious medical disorder.

Officials at the Substance Abuse and Mental Health Services Administration say they expect to see more cases of people sickened by the adulterated cocaine as doctors learn of the association. The drug mixture has caused agranulocytosis, a life-threatening disorder that causes a drop in the number of white blood cells. Two deaths have occurred among the 20 confirmed or suspected cases related to adulterated cocaine.

Levamisole is used in cattle, sheep and swine to prevent parasites. It is not approved for human use.

It is unclear how and why levamisole is turning up in cocaine. Drug Enforcement Administration testing shows the amount of levamisole-laced cocaine in circulation in the United States has been increasing since 2002. In samples of illicit cocaine analyzed in July, more than 70% contained levamisole. A recent study performed in Seattle found that 80% of people who tested positive for cocaine also tested positive for levamisole.

Agranulocytosis comes on very fast with severe symptoms. People who use cocaine should watch out for high fever, chills, weakness, swollen glands, painful sores in the mouth and anus and any infection that won't go away or gets worse very fast.

-- Shari Roan

Photo: Levamisole is used to treat livestock for parasites but has been showing up in cocaine. Credit: Danny Johnston / Associated Press