Narcotics: Problems and Solutions of this Global Issue
On November 24 and 25, 2016, the Pontifical Academy of Sciences (PAS) held a meeting at the Vatican with international experts, led and inspired by Pope Francis and Queen Silvia of Sweden, to develop a global view of the current drug epidemic and recommendations to reverse this trend, one that imperils the very elements of civil society: public health, safety and human progress. Millions of victims globally have succumbed to addiction. This is a contemporary version of slavery. It destroys autonomy and free will, a foreseeable outcome of using chemicals that artificially suppress and supplant natural brain reward systems in vulnerable people. Addiction especially threatens young people, as the vast majority of addictions can be traced to initiation during adolescence. This is a period of rapid brain development, with particular risk to the enduring harms of drug use. An essential priority is to protect the brains of children and youth, by discouraging use of all drugs. The international epidemic is led by a globalized network of criminals and legal business interests, with children and youth as their primary targets. They have driven exponential growth of potent forms of cannabis, developed unclean highly addictive cocaine preparations, and created unregulated new psychoactive substances. Prescription drug diversion for non-medical misuse is rooted in different origins, but the risks of medication misuse can be as great or greater than illegal drugs.
Support the three UN treaties governing licit and illicit drugs, which are signed by virtually every nation. These treaties permit medical use of drugs, with tight regulations to prevent diversion for non-medical use and which criminalize the nonmedical sale and use of these same chemicals.
Commentary: Unfortunately, criminalization alone may not be much of a deterrent. There are tight regulations to prevent diversion. However, in the United States, the rate of heroin overdoses is alarming. In Louisville, KY on February 12th 2017, there were 52 overdose calls in 32 hours probably from illegal Fentanyl-laced heroin. Targeting law enforcement and treatment seems more prudent. It has been noted that from 2000 to 2014 there was a 3000% increase in people seeking opiate/opioid treatment. However, treating the hypodopaminergic brain condition that drives addiction and all Reward Deficiency Syndrome (RDS) might be a better long-term goal. More funds need to be allocated for prevention strategies rather than to law enforcement. Governments have a moral and ethical responsibility to secure and defend the common good of their citizens. As trafficking of drugs imperils the health, security and the rule of law in nations, any compromise can be viewed as complicity.
Commentary: While it is true that complicity about drug trafficking imperils health, security and the rule of law, it is also true that complicity concerning the lack of research funding reflects the worse governmental and foundational complicity around the globe. Understanding and treating the cause of all addictive behaviors known as RDS needs to coincide with intergovernmental cooperation to enforce agreements to curb drug trafficking. Governments must unequivocally pursue drug trafficking at every level. They have a responsibility to denounce and criminalize corrupt banks, bankers and money launderers that profit from the drug trade, and thwart large-scale and local drug trafficking. Governments must not engage in any public, private or covert agreements to gain financial support for political or personal reasons from drug traffickers or industries. Such agreements subvert the common good, trust, health and safety of their people, especially, their youth.
Commentary: These statements make for bold and consequential goals for governments to pursue. Money from opium growing is currently being used to finance wars and cartels. Indeed the US government was accused of supporting Contra cocaine traffickers in Nicaragua in the 1980’s. Criminalizing bankers and thwarting global and local drug trafficking is no small task. Instead, governments have a public health, legal and moral responsibility to confiscate the gains of these traffickers/industries and to use these proceeds to fund assistance programs for the victims, which include providing treatment, prevention, and medical services, family support, as well as educational and employment opportunities.
Commentary: The idea of funding research has been left out of this statement. It is the old “chicken & egg” conundrum whereby, for example, new treatments involving medical devices and even new anti-craving substances both pharmaceutical and nutraceutical could be supported by confiscated gains from traffickers/ industries. The experiments in Colorado and Washington with recreational marijuana may provide insights into, how money could be used to develop prevention tactics especially geared to our youth and in schools, as well as funding treatment, independent of insurance carriers. Instead of providing treatment, prevention, and medical services, family support, educational and employment opportunities, some insurance companies flout the parity laws established under the Affordable Care Act and evoke Suicide ideation (SI) as being the only diagnosis acceptable for third party payment for residential addiction treatment past detox. This tactic of insurance carriers is as dangerous as the other aspects of drug trafficking. Governments should NOT use any ill-begotten gains from drug trafficking or sales to generate political messages, regulations or laws that foster use of abusable drugs and subvert public health and safety laws and regulations.
Commentary: The only time politics should play a role in providing for the health and safety of our people both young and old, is when new protective laws could be enacted to offset the perils of both drug and non- drug addictive behaviors. Although it is very unlikely that the recent Opioid epidemic in the US was a plot supported by money from drug trafficking, it was very likely an unintended consequence of political messages, regulations or laws. It may have originated with the idea of treating chronic pain as the fifth vital sign. In 1998, this idea lead to the release of a recommended policy from the Federation of State Medical Boards “reassuring doctors that they wouldn’t face regulatory action for prescribing even large amounts of narcotics, as long as it was in the course of medical treatment.” The federation said it received nearly $2 million from opioid makers since 1997. Reject drug legalization for recreational purposes as a hopeless, mindless strategy that would consign more people, especially the disadvantaged, youth, the poor and the mentally ill, to misery or even death while compromising civil society, social stability, equality, and the law.
Commentary: Action speaks louder than words, the “War on Drugs” and prohibition failed. While this is indeed the most difficult aspect related to our current drug epidemic, there are two sides to the coin. Certainly, we know from scientific evidence that abuse of marijuana, especially at very high THC concentrations (up to 97% in some wax forms), can induce harmful mental consequences including psychosis and dependence. On the other hand, incarceration is not the answer either; this has failed. Truly understanding both the neurogenetic trait and epigenetic (environmental) state involved in addictions and educating the wider public about the consequences for our youth of legalization of recreational marijuana may succeed. Neurobiologically, the brain regions involved in decision –making are compromised in our youth because myelination continues until individuals reach 24-25 years of age. It is also known that low dopamine function (dopamine D2 receptors numbers decline with age) can induce aberrant substance or non-substance behavioral addictions in elders. The most intelligent approach is to provide strict regulations on the sale of marijuana products. While the SMART group has good intentions, it is human nature for people to want to get “high.” As thinking minded people we must begin to carefully craft workable laws against human nature instead of harmful thoughtless unenforceable doctrines. Create a balanced drug strategy, coordinating public health and criminal justice systems to curtail supply, discourage drug use and promote recovery – as a more effective method to treat addiction than incarceration. The primary goal of addiction treatment is long-term care and recovery.
Commentary: Definitely, we, as right thinking people should discourage drug use and promote recovery without incarceration of the victims of uncontrollable addiction. However, we must also appreciate that like any chronic disease/disorder/syndrome; RDS could be a life –long issue. In fact, there is enough scientific evidence to strongly suggest that at least 50 % of the contribution is genetic and the other 50% is epigenetic (environmental). The concept of long-term in the world of insurance carriers translates to an uncanny short –term detox and months of outpatient treatment. This of course borders on the ridiculous because if genetic polymorphisms in the reward system of the brain are involved this could very well be a life –long condition. The foundations of this balanced strategy are fundamental human rights, which include drug prevention and recovery among the world’s diverse faith communities, with a special focus on the goal of protecting youth from drug sales and drug use, in accordance with Article 33 of the Convention on the Rights of the Child.
Commentary: While it is well recognized that the world’s diverse faith communities provide indispensable positive work to prevent or protect youth from imbibing, drug prevention and recovery should be universal and reach out to non-believers as well. It must be recognized that while certain gene variations have been linked to an acceptance of God, other gene variations seem to prevent such acceptance. While religion may have positive benefits including self-help organizations, it is the biology not faith, that induces craving for aberrant drug and non- drug seeking behaviors. Faith can help heal, but without addressing the core neurobiology of the condition, the recovery process is filled with white knuckle resistance and possible relapse and addiction transfer, moving from one addiction to another such as gambling, overeating and more. However, a certain percentage seems to prevail by accepting the doctrine of “becoming powerless.” Nevertheless, independent of religion we should uphold Article 33. “(Drug abuse): Governments should use all means possible to protect children from the use of harmful drugs and from being used in the drug trade. The prevention of addiction among youth (less than age 21) is a high priority, and achievable by rejecting the use of marijuana and other rewarding substances.
Commentary: Addiction professionals are concerned about any involvement preteenagers and young adults’ have with substance abuse. The development of the Pre-Frontal Cortex (PFC) is undergoing significant changes in adolescents prior to reaching the mid-20s, and, appropriate decision making in this population is hijacked. These concerns provide the impetus to continue relevant animal and human neuroimaging studies. Early genetic testing for addiction risk alleles will offer valuable information that could potentially be utilized by their parents and caregivers to encourage the rejection of the use of marijuana, and other rewarding substances. To combat this significant global dilemma and help our youth lead normal productive lives, epigenetic (environmental) influences, including attachment -known bonding substances oxytocin/vasopressin and parenting styles, may modify various reward genes which effect dopaminergic function. The underlying reasons for this priority need to be conveyed to youth and their parents in collaboration with health, educational and local communities.
Commentary: This is easier said than done. It seems on the surface a good orderly goal involving parents, young people and even educational systems. This idea had some of its early beginnings in the late 60’s but has failed. Our young are influenced by their peers to use or even abuse, and by their parents drinking alcohol, taking pain pills, long –term stimulants prescribed for ADHD or weight loss, smoking marijuana, and being too busy in the pursuit of the ”American Dream. We all need a change in not just what we say to our youth but what we do. Educate the public with up-to-date scientific information on how drugs affect the brain, body and behavior, to clarify why legalization of marijuana and other drugs for recreational use is poor public policy, poor public health policy and poor legal policy.
Commentary: While this statement seems reasonable and at least in the United States and other countries, the enormous efforts of the National Institute on Drug Abuse (NIDA) and National Institute on Alcohol Abuse and Alcoholism (NIAAA) continue to feed the public with up-to-date scientific information on how drugs affect the brain, body, and behavior (including marijuana). Education alone is not the real answer. Through the advent of neuroimaging and genetic tools, we are unraveling the mysteries of how drugs work on the brain and body. Just recently, NIAAA published in Biological Psychiatry, a neurobiological framework to be incorporated in potentially targeting all RDS behaviors involving both genetics and neuroimaging. The work of others further framed this neurobiological approach in Austin, Texas showing that 1,000 or more genes are altered up or down by alcohol and the hunt for substances to reinstate “genetic normalcy” may have powerful benefits in the future. With this in mind, based on neuroscience a “reward deficiency solution system” that combines early genetic risk diagnosis, urine drug monitoring, and nutrigenomic dopamine agonist modalities and mRNA reward gene expression pre-and post treatment has been proposed. Harness religion to support substance abuse prevention and treatment. Drug use can devastate the soul and a loving relationship with God. Drug use in our communities tests our faith. The faithful have a precious opportunity to engage in preventing this tragic form of modern chemical slavery. For those now enslaved, they can confront the challenge of addiction and achieve their emancipation.
Commentary: While the concept of God should not be underestimated and many studies have verified its positive effect; the idea that acceptance of GOD can achieve emancipation from locked in addiction seems simplistic. We must embrace the fact that “reward deficiency” (hypodopaminergic function) the cornerstone of all repetitive addictive behaviors, is based in neurobiological, genetic, and epigenetic antecedents expressed in unwanted uncontrollable seeking behaviors. So, although engaging and accepting spirituality alone to prevent or recover from this” tragic form of modern slavery” is counter-intuitive, it would have some positive epigenetic effects. However, would it be more reasonable to achieve the laudable goal of prevention by initiating at birth a validated genetic test to determine risk for RDS? Not to label a newborn, but together with a balanced view of spirituality, provide more natural ways over time to boost dopamine function. Many activities can boost and maintain natural “pro-dopamine regulation”. They include music, art, food, exercise therapy, meditation, Yoga and neutraceutical dopamine agonist therapy. We must realize that the use of powerful narcotics like methadone and buprenorphine, with or without a narcotic antagonist, does not heal addiction. Instead, it locks people young and old into an addictive state, blocking natural dopaminergic function. The real chance to not just achieve emancipation but real-time prevention is to find ways to bring about “dopamine homeostasis.” Acceptance of God for some (with the God acceptance gene) is just the beginning of the journey.
Kenneth Blum, B.Sc. (Pharmacy), M.Sc., Ph.D. & DHL; received
his Ph.D. in Neuropharmacology from New York Medical College
and graduated from Columbia University and New Jersey College
of Medicine. He also received a doctor of humane letters from Saint
Martin’s University Lacey, WA. He has published more than 550
abstracts; peer-reviewed articles and 14-books.