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The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.
Trends in Drug Related Hospitalisations (Aust 1999-2020)
Cannabinoid Related Hospitalisations – Biggest Increase: In 2019-20, there were 6,427 cannabinoid-related hospitalisations (including cannabis and synthetic cannabinoids), which equates to an age-standardised rate of 26 hospitalisations per 100,000 people. This is the highest rate recorded over the course of monitoring and is more than double the rate observed in 1999-00 (11 hospitalisations per 100,000 people), and an increase relative to 2018-19 (24 hospitalisations per 100,000 people; p<0.001)
The per cent reporting any use of cocaine in the past six months increased significantly from 68 per cent in 2020 to 80 per cent in 2021, the highest per cent observed since monitoring began, although frequency of use remains low.
The per cent reporting any use of ecstasy capsules in the past six months declined significantly in 2021 (from 83 per cent in 2020 to 70 per cent in 2021), as did the per cent reporting use of ecstasy pills (53 per cent in 2020 to 42 per cent in 2021) and ecstasy powder (35 per cent in 202 to 26 per cent in 2021). The price of all forms of ecstasy significantly increased in 2021, and there were significant declines in the perceived purity and availability of ecstasy capsules and crystal, suggesting a disruption to the MDMA market compared to 2020.
The per cent reporting use of ketamine in the past six months significantly increased from 43 per cent in 2020 to 52 per cent in 2021, representing the largest per cent reporting recent use since monitoring began. Frequency of use, however, remained low and stable at a median of three days in the past six months.
Reported recent use of non-prescribed pharmaceutical stimulants significantly increased from 39 per cent in 2020 to 46 per cent in 2021, as did the per cent reporting any recent hallucinogenic mushroom use (30 per cent in 2020 to 45 per cent in 2021), although frequency of use remained low for both.
Almost three-fifths (58 per cent) of the national sample reported any e-cigarette use in the six months preceding interview, a significant increase from 39 per cent in 2020. Frequency of use also increased, from a median of 7 days in 2020 to 30 days in 2021
(Dalgarno Institute Comment: It is interesting to note that even in this snapshot of the data that, from where we sit, the substances that have received ‘positive’ press, or little attention in the marketplace have increased in use. However, the substances that have had some negative focus, and restrictions placed on use ‘opportunities’, due to the pandemic (i.e. ecstasy at non-existent music festivals) have declined. Of course, interrogating the data requires more than an anecdotal swipe, but it remains an observational reality, none-the-less. Permission models continue to drive demand and extinction focused vehicles, when given even part sway, can shift demand down)
Drug involvement at the most recent FDV (Family/Domestic Violence) incident was also associated with over twice the odds of injury and significantly greater negative life impact. The findings that drug use increases both the risk for and impact of FDV indicate the need for policy that advocates for interventions addressing both drug use and violence in combination.
Results of Major Study on Impact of Microdosing Published
Researchers from Imperial College London have carried out the largest placebo-controlled trial into psychedelics to date and found that small doses of LSD boost the psychology of users in a manner of ways.
However, when the researchers examined what trial volunteers took, they found placebos worked equally as well as the drug. In short, the uplift reported by microdosers might be nothing more than the placebo effect.
Balázs Szigeti, the lead author and a research associate at Imperial’s Centre for Psychedelic Research, said:
“Our findings confirmed some of the beneficial psychological effects of microdosing from anecdotal reports and observational studies, such as improved sense of wellbeing and life satisfaction.”
“But we see the same improvements among participants taking placebos. This suggests that the improvements may not be due to the pharmacological action of the drug but can instead be explained by the placebo effect.”
The trial, launched in 2018, recruited 191 members of the public who were already microdosing with LSD and able to participate online. The volunteers followed instructions to prepare gel capsules containing either a low dose of LSD, estimated at about 13μg, or a placebo. They then followed instructions to muddle up the capsules in envelopes bearing QR codes so they did not know which they took when.
During the study, the researchers used scans of the QR codes to log when each participant took a placebo versus a microdose of LSD. Throughout the four-week trial, the volunteers completed surveys on how they felt and performed a series of online cognitive tests. Typically, those on the trial reported feeling a psychological boost within a few hours of taking either LSD or placebo capsules.
The scientists found that those who microdosed for four weeks reported improved wellbeing, mindfulness and life satisfaction, along with reduced feelings of paranoia. But the placebo group also improved – to such an extent that there was no statistical difference between the two. The findings, published in eLife, suggest the expectation of taking a small dose of the drug was as good as taking the drug itself.
While the scientists believe the results are valid, they concede that the study is not as robust as a standard, laboratory-based placebo-controlled clinical study. Since the participants sourced their own drugs, it is impossible to be sure what doses each ingested, and many of the participants were evidently familiar enough with the effects of the drug to guess whether they had taken a microdose of LSD or a placebo capsule.
James Rucker, a clinician scientist who runs the psychedelic trials group at King’s College London, and was not involved in the research, said:
“This suggests that the perceived beneficial effects of microdosing psychedelics in this group are more likely to be a result of positive expectation than the capacity of the drug to induce a beneficial effect.”
While it is possible the study was too small to detect a beneficial effect, Rucker said that if that was the case, then the improvement was likely to be so small that it might not have much real world impact anyway.
“It remains to be seen whether microdosing may have therapeutic effects in patients with a defined mental health condition such as depression, or over a longer time period,” he added. “These are tractable hypotheses and we should be able to explore them with trial designs where participants receive legal microdoses of psychedelics of known purity and quality. However such studies are largely impossible under the UK government’s Schedule 1 restrictions, under which all classical psychedelics are classified.
This popular claim lacks evidence and leads to poor policy.
The notion that drug addiction is a brain disease has become axiomatic. Around the globe aspiring health professionals treating substance abuse are indoctrinated with this belief, especially after the idea became popular in the 1990s. Its popularity extends far beyond the hallowed halls of academia. Both the May 1997 Time and the September 2017 National Geographic magazines were dedicated to the brain science of addiction. Numerous other popular magazines have run similar cover stories over the past two decades.
But after 20 years of research, one of us (Hart) saw that paradigm yielding dismal results. Meanwhile, behavioral research on outcomes after providing both animals and humans with attractive alternatives to drugs has yielded positive results regarding effective treatments, despite the lack of mainstream attention.
Despite this seemingly solid scientific consensus, there are virtually no data in humans indicating that addiction is a disease of the brain in the way that, for instance, Huntington’s or Parkinson’s are diseases of the brain. The existing paradigm is based on intuition and political necessity, not on data and useful clinical results. Yet the diseased-brain perspective has outsized influence on research funding and direction, as well as on how drug use and addiction are viewed around the globe. This situation contributes to unrealistic, costly, and harmful drug policies: If the problem is a person’s neurobiological state after exposure to a drug, then either the drug must be eradicated from society through law enforcement or an individual’s brain must be treated. In such a myopic approach, the socioeconomic and societal factors that contribute to drug addiction are considered a footnote in research, clinical practices, and policy, despite their apparent importance. (see also DRR: Dealing With Addiction)
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