By Lev Facher Jan. 17, 2023

Increased injection drug use has led to a spike in cases of the life-threatening heart condition endocarditis, with cases rapidly accelerating since the onset of Covid-19.
The increased case count is one of the lesser-known side effects of the deadly addiction epidemic. But patients with endocarditis, an inflammation of the heart lining caused by infection, require complex, thoughtful care — care that the U.S. health system is ill-equipped to provide.
With drug deaths hovering at an all-time high and endocarditis cases among drug users up nearly tenfold in the last decade, physicians, researchers, and health officials have begun to confront the problem with more urgency. In particular, doctors are coming to terms with a basic reality: Their hospitals often have few protocols for treating endocarditis patients who use opioids and the withdrawal they’ll likely experience upon admission.
Between 2011 and 2022, the rate of new endocarditis among patients with opioid use disorder increased dramatically, according to new research published by the National Institute on Drug Abuse and scientists at Case Western Reserve University. Among drug users, most endocarditis infections stem from the use of non-sterile syringes, allowing bacteria to enter the bloodstream and, eventually, the heart.
Among people with opioid use disorder, the rate of endocarditis jumped from 4 per million per day to 30 per million per day. The sharpest increase occurred between 2021 and 2022
Such care is complicated to begin with. But for patients with addiction, each of those steps adds a new layer of complexity — in particular, lengthy hospital stays and ensuing withdrawal for patients accustomed to regular opioid use.
“You have someone that has very strong physical dependence to opioids, they go into the hospital, and they go into withdrawal, and that withdrawal can be very, very severe,” Nora Volkow, NIDA’s director and the co-author of the recent study, said in an interview. “They may leave the hospital against medical advice, because they’re not being treated for the severity of the withdrawal symptoms.”
Even when patients’ withdrawal is treated, Volkow said, patients “stay throughout the whole hospitalization as needed — and then they get released with no linkage to treatment or care.”
Keeping patients in the hospital, however, is only half the battle. In cases where patients remain in treatment, many still don’t receive the resources they need, or the expertise their care requires.
Even once patients’ infection and heart condition has been addressed, discharging them from the hospital can present unique challenges. Many of those who inject drugs are also experiencing dangerous or unpredictable housing situations, and those whose addictions remain untreated often quickly return to use.
For complete article Serious heart inflammation spikes amid injection drug crisis - STAT (statnews.com)

(Dalgarno Institute Comment: “Walking” into drug use is easier and easier; With Harm Reduction mantras of ‘personal liberties’ ‘rights to use in one’s own body – autonomy’ and ‘right’ to health care, all with impunity, bludgeoning the surrounding culture into compliance with faux pity declarations, that are all masking this growing anarchy.
So, what is the response to this convoluted, intricate, and intensive care required mess?
To continue to enable, equip, empower and by default completely endorse, ongoing drug use.

• More syringes
  
• Drug Consumption Rooms
  
• Greater permission models, both tacit and direct, with weakened policy and legislation.
  
• Continuing drug use
  
• No facilitated path to exiting drug use
  

These, as all pro-drug activists know, will actively undermine both Demand and Supply Reduction policies and practices, enabling the chaos that is dependency and addiction to grow – and glibly spruiking to the uninformed non-drug user that… “see prevention doesn’t work, just make it a health issue and we’ll fix these incidental unpleasant anomalies with the health care system!”
Of course, the black hole of public health debt just keeps growing as many of the short and long term harms of drug use assault the health and welfare system with inexorable demands – not least permanent negative mental and physical health outcomes.
Ah, then comes the well scripted… “See, if you legalise drugs and sell them, the revenues can be used to pay for this humanity diminishing and destroying outcomes”. The obvious answer in this article context is that opioids, for the most part, are legal but are being misused. So, there is not ‘revenue stream’ from this nightmare. Touting the cannabis option will fail too, as we have now seen in US and Canada that no such revenues eventuate, but to the contrary, even greater expenses are incurred.

• Up In Smoke – The Californian Legalization Disaster
  
• No State Successful in Regulating Marijuana
  
• Economic & Social Costs of Legalizing Marijuana
  
• Then There were Three – Marijuana Markets paper
  

When we ask the following questions in forums, the answers are always silence or in the negative.

• Does anyone here believe their children or grandchildren will be better off on illicit drugs?
  
• Does anyone here believe their children or grandchildren will be better off with easier access to illicit drugs?
  

Our movement has interacted of many decades with thousands of individuals and families who all too well know the utter grief that drug use brings. Many of those voices were heard and recorded in Federal House of Representatives Standing Committee on Family and Human Services Report – The impact of illicit drug use on families in 2007, but have been ostensibly ignored.
We know prevention and demand reduction work – Tobacco decline in Australia has proved that. When all of the community – Government, Education, Health, Media and Community sectors act with One Focus, One Message and One Voice, change happens.
We did it with Tobacco, with Litter, with seat belts, speed limits and the list goes on. You don’t reduce demand by prohibiting on paper and permitting in practice, that cognitive dissonance right there undermines public will.
The health harms of tobacco pale next to the health, well-being, familial and safety harms of illicit drug use – so what is stopping us, stopping this?
The War We Never Fought – a Review of Journalist Peter Hitchens Book.
By Dalgarno Institute Communications Team

A new paper argues that excitement has veered into misinformation—and scientists should be the ones to set things straight.

CONCLUSIONS: On the basis of the change in depression scores on the QIDS-SR-16 at week 6, this trial did not show a significant difference in antidepressant effects between psilocybin and escitalopram in a selected group of patients. Secondary outcomes generally favored psilocybin over escitalopram, but the analyses of these outcomes lacked correction for multiple comparisons. Trial of Psilocybin versus Escitalopram for Depression | NEJM

IN APRIL 2021, a widely anticipated paper in the field of psychedelics dropped. The study, a small trial run at Imperial College London and published in The New England Journal of Medicine, investigated the use of psilocybin, the active ingredient in magic mushrooms, to treat depression. Led by Robin Carhart-Harris, who now directs the Neuroscape Psychedelics Division at the University of California, San Francisco, the research compared psilocybin with a standard antidepressant. The findings were somewhat lackluster: it found that the psychedelic was only marginally better than traditional treatments at relieving depression.

Back in 2017, Rosalind Watts, an author on that paper and a former clinical lead for the trial at Imperial, had given a TEDx talk on the power of psilocybin to treat depression, prompted by the time she had spent working on the study. In the talk, she shared her belief that psilocybin could “revolutionize mental health care.” But in February of this year, Watts published a Medium piece in which she expressed regret at her initial unbridled enthusiasm. “I can’t help but feel as if I unknowingly contributed to a simplistic and potentially dangerous narrative around psychedelics; a narrative I’m trying to correct,” she wrote.

“I just reflected on how I myself had got caught up in the black and white of like, ‘This is wonderful,’” she says today. “Now having been through that trial … I’m much more neutral and agnostic.”

Scientists’ unwillingness to accept criticism makes Corlett pessimistic about the future of psychedelic research. “Science is meant to be somewhat adversarial. It’s not meant to be presided over by a single group of people,” he says. “I’m still open and excited about the possibilities, but I think this kind of breathless rush to translation and to a conclusion is really dangerous.”

And in an ethically murky turn, for those in the field who have begun to dabble in the corporate side of psychedelics, hyping up findings has become of obvious interest. Declaring conflicts of interest is standard practice in academia, and for good reason: Would you trust a paper that declared that spending more time on Instagram makes you happy if the lead author was receiving money from Meta? But that happens on a regular basis in psychedelic research; many in the field have accepted board positions or consulting fees for the ever-expanding number of psychedelic companies. That means “it’s literally a financial incentive to hype the results,” says Yaden. Watts agrees: “I think for research to be truly solid and not hyping things, it needs to be separated out from the interests of the companies who have stuff to gain.” (For complete article go to WIRED )

Further Reading - Expectation, Excitation, Subjectivity, Idiosyncrasy, Placebo, and the Psychedelic Micro-dosing Experiment

Expectation, Excitation, Subjectivity, Idiosyncrasy, Placebo, and the Psychedelic Micro-dosing Experiment

A systematic study of microdosing psychedelics: Taken together these findings paint an intriguing picture. We found clear changes in a small set of psychological variables: decreased depression and stress; decreased mind wandering; increased absorption; and increased neuroticism. Notably, these variables were not those that participants most expected to change. If the current findings were entirely due to expectation, then we should have seen changes in those variables that are most commonly discussed in media and online accounts of microdosing, and in those variables rated highest in Study Two. In fact several of the most commonly discussed effects of microdosing and the effects most expected to change (creativity, wellbeing, mindfulness) showed no evidence of alteration whatsoever. This suggests that the longer term changes we identified were unlikely to be due to expectation.

On the other hand, although we did identify clear short term changes following each microdose in the daily analyses, the longer term changes identified in Study One were unrelated to the total number of doses participants ingested during the study period and also unrelated to participants’ prior microdosing experiences. This surprising lack of a relationship between the overall quantity of microdoses and the degree of subjective effects is a reason to interpret these findings cautiously. At face value this suggests that any engagement with microdosing, whether a single dose or relatively frequent dosing, can impact the variables we identified. This may be the case, but it is also possible that participants’ self reports of dosage and frequency in this study were not precise enough to accurately characterise dose related effects.

Overall, these findings suggest several disconnects between the popular narrative around microdosing and the experience of microdosers in this sample. Participants in Study One microdosed less often than is recommended in most online protocols and did not report that many of the immediate effects of microdosing lasted beyond the day of dosing. Although popular accounts of microdosing describe sustained boosts in productivity and creativity [16–18], the longer term effects we identified mainly involved reduced mental distress and changes in constructs such as absorption and mind wandering that are not as commonly discussed. This suggests that microdosing may lead to more subtle changes characterised by improvements in mental stability, the capacity to sustain attention and increased ability to become engaged in intense imaginative experiences.

The most surprising finding was that neuroticism also appeared to increase following microdosing. This is not something that is discussed in popular accounts of microdosing and was not what participants expected in Study Two. This highlights an important and under discussed aspect of microdosing: not everyone has a positive experience. Although the majority of participants’ comments were positive (and even glowing), there were a subset of comments that reflected unease about microdosing (see Table 5). In a context of considerable hype around the practice of microdosing, particularly with regards to it’s potential as a business tool, it important to acknowledge that microdosing may not be universally beneficial. These findings highlight the need for further research into the full range of microdosing effects (positive and negative) and also for investigations into subtypes of individuals who may particularly benefit from or be adverse to the practice.

Strengths, limitations and future directions

This was very much a preliminary and exploratory study of microdosing, and there are clear limitations to the study design. This was a self reported observational study and as such, we relied on participants’ accuracy and honesty in their reports of doses and effects, and also on their continued responsiveness throughout the study period. Recruitment for this study occurred through online forums that were mainly very positive about the effects of microdosing. As such, these results may be affected by sampling bias, and may under represent individuals with negative or ambivalent experiences of microdosing. Furthermore, as might be expected in an observational study of individuals who are interested in psychedelics, there was some concurrent use of higher dose psychoactive substances and non psychedelic substances that may have had some influence on these results. A better design would certainly be to conduct an experimental study with controlled doses of known substances and a placebo comparison condition. The legal and bureaucratic limitations around psychedelic research make the approval process for such a study prohibitive. As an alternative, in implementing the current design we aimed to demonstrate that it is possible to investigate the effects of psychedelic substances in a systematic observational paradigm, using an automated and anonymous communication system.

It is clear from this research that there is a high level of popular interest in microdosing, that many people are engaged in this practice, and that there are strong expectations about the various effects that microdosing can have. The current findings suggest that popular accounts of the effects of microdosing may not match the experience of long term microdosers, and that promising avenues for future investigation are the impacts of microdosing on improved mental health, attentional capabilities, and neuroticism.

For complete study

Further Reading

Psychedelics: The New Panacea – Just Like Cannabis, it will Fix Everything, Won’t it? 

Download Papers

Position Use of Psychedelic Empathogenic Agents APA 2022

A Systematic Study of Microdosing 2019

Start smoking – lead to e-cigarette use! Start vaping – lead to smoking! #quit 

Conclusion Our study replicated the positive relation between e-cigarette use and tobacco smoking in both directions for adolescents. This may mean that the gateway works in two directions, that e-cigarette and tobacco use share common risk factors, or that both mechanisms apply.

For complete research 

E-Cigarettes labelled ‘public health crisis’ A damning Research has warned of the “public health crisis”

E-Cigarettes are creating, putting a new generation at risk of a range of illnesses.

(Australian National University)