There is general epidemiological agreement that a broad-based cocaine abuse epidemic has occurred in the United States between 1980 and 1986, the peak of which is not yet in sight. There is also a widespread and increasing prevalence of more intensive use of rapid delivery forms of cocaine, including free-basing and injection, as well as a tendency to use the drug in a multiple drug abuse context. The rise in cocaine indicators has been dramatic. The dramatic increase in cocaine abuse in the U.S. over the past five years - accompanied by a significant increase in problem indicators - has engendered two salient phenomena: cocaine abusers also abuse other drugs; and cocaine abusers are seeking treatment for physical dependence on cocaine, something unheard of just a few years ago. Recent data from the Cocaine Hotline indicate that 87 percent of cocaine abusers also abuse other psychoactive drugs, the most common being alcohol. This increase in cocaine-alcohol abuse, coupled with this country's serious alcohol abuse problem, has increased the need for a clinical understanding of cocaine-alcohol abuse patterns and treatment. Clinical experience with drug dependence supports the theory that cocaine dependence has the characteristics of a similar addictive disease process - alcoholism. However, cocaine dependence may have different toxic, sociocultural and legal consequences than alcoholism. Cocaine addiction has the characteristics of a chronic, relapsing and potentially fatal disease as well as many other characteristics similar to alcoholism. When addiction is defined as compulsion, loss of control and continued use in spite of adverse consequences, cocaine may be perceived as an agent of addictive disease. The behavioral, social and psychological sequelae of cocaine addiction follow the same basic patterns of addiction to alcohol, amphetamines and opiates.
In December 1972, an 18-year-old male apparently took an accidental overdose of heroin. After becoming ill, he attempted to receive treatment for his condition by being admitted to the emergency room of Wahiawa General Hospital. When confronted by attending physicians in the emergency room as to the nature of his illness, the youth stated that he had only eaten 10 hallucinogenic mushrooms (an average dose for Copelandia cyanescens, the mushroom in question) and nothing else. This story was most likely concocted either by the youth himself or by some of his friends, who probably thought that they could or would be prosecuted for the use of an illegal substance. It is not uncommon that when confronted by an overdose of drugs, many young people are afraid to report their illness to the proper medical authorities out of fear of prosecution due to their illegal activities (Young et al. 1982). The doctors who attempted to treat this young man should not be held liable for his death, even though their treatment of the patient was more supportive (i.e., the talk-down method) than pharmacological. They had no way of knowing that the patient had lied to them about his condition. While it is true that several doctors had diagnosed Gomilla as possibly suffering from muscarine poisoning, why was no atropine or scopolamine administered to the patient? And why was his stomach not pumped and specimens collected for a toxicologist to study for the presence of toxins?(ABSTRACT TRUNCATED AT 250 WORDS)
Although Americans have experienced many drug epidemics, the majority of which have ended within ten years of onset, they nevertheless believed that the use of smokable cocaine, which took the popular form of crack cocaine in 1984, would grow exponentially throughout the 1990s unless it was vigorously combated. However, in 1991 it appears that crack use is in decline even in the inner-city neighborhoods where it had been most entrenched, and that the decline is due more to natural controls than to the War on Drugs. The cyclical nature of drug epidemics, as well as their progression through regular stages, was again affirmed. The cocaine-smoking epidemic of 1981-1991 (which included crack) afforded the opportunity to research it in its entirety. In this article, the advantages of recognizing the developmental cycles of drug epidemics are outlined, the most important of which concerns the future. In the terminal stage of the developmental cycle of a drug epidemic, remaining abusers play a pivotal role. If humanely treated, they may serve as deterrents to future drug use: frustrated in current drug use, however, yet insensitively treated by the wider society, they may author the next epidemic.
Between 1985 and 1988, the estimated number of current marijuana users (i.e., use within the past 30 days) in the United States declined 36%, based on self-report data from the National Household Survey on Drug Abuse. During the same time period, estimated nondomestic production of marijuana available for consumption in the United States increased 58% and domestic production increased 119%, while there was no clear-cut trend in prices. Reports of marijuana use associated with emergency room visits more than doubled in these years. The reasons for these apparent discrepancies in the data regarding the supply and use of marijuana are unknown. The possible causes of change in these and other measures of illicit drug use are examined because they form the basis for assessment of the efficacy of the recently proposed 1989 National Drug Control Strategy.
To recapitulate the above findings: Heroin: 1. From burglary analysis: upper limit of 12,700 users in 1986. 2. From CSAS roster: lower limit of 8,363 abusers in three-year period (fiscal years 1985-87). 3. From capture-recapture method: 14,900 users in fiscal year 1987. 4. From methadone decedent analysis: 10,300 abusers in 1986 and the first half of 1987. Speed: 1. From data on gay males: 4,600 regular users in 1987. 2. From CSAS roster: lower limit of 1,214 abusers in fiscal years 1985 through 1987. 3. From capture-recapture method: 5,400 users in fiscal year 1987. IVDUs: 1. From data on Black IVDUs: 19,400 in 1987. 2. From data on Latino IVDUs: 21,100 with lifetime histories in 1987. 3. From CSAS roster: lower limit of 9,350 in fiscal years 1985 through 1987. These estimates can now be assessed, keeping three cautions in mind: (1) different time frames are involved; (2) some estimates are useful only to establish lower or upper bounds; and (3) there is a difference between users (the Coroner reports on decedents who may have used a drug but once) and abusers. The present author's analysis of recent trends in heroin and speed use in San Francisco (Newmeyer 1987) suggests that the number of abusers of each of these drugs was fairly constant between 1985 and 1987. With regard to heroin, the estimate that best meshes with the findings of the present study is that between 10,000 and 12,000 San Franciscans were abusers during 1987. Of these, more than 90 percent used the drug primarily by the IV route.(ABSTRACT TRUNCATED AT 250 WORDS)
Observation of the real world of social marijuana use, where autotitration is the norm, renders the scare tactics of the new marijuana proponents not only inaccurate but irrelevant. There is much published evidence about the availability of highly potent varieties of cannabis from the nineteenth century through the present day. The effects attributed to the new marijuana are the same ones debated for centuries in many different cultures. The assertion that "all marijuana research to date has been done on 1 or 2 percent THC material" (Cohen 1968) ignores several thousand years of human experience with the drug. The old medical cannabis extracts were stronger than most of the forms now available, though the potency of illicit hash oils by the mid-1970's was approaching the level of medicinal preparations available before their removal from the USP. While it may be true that sinsemilla is more widely available than 10 or 15 years ago, its potency has not changed significantly from the 2.4 to 9.5 percent THC materials available in 1973-1974 (see Table I), or the five to 14 percent sinsemilla of 1975 (Perry 1977). The range of potencies available then (marijuana at 0.1% to 7.8% THC, averaging 2.0% to 5.0% THC by 1975) was approximately the same as that reported now. With such a range, the evidence simply cannot support the argument by Cohen (1986) that marijuana is "ten or more times more potent than the product smoked ten years ago." And to say that marijuana potency has increased 1,400 percent since any date in history is patent nonsense.(ABSTRACT TRUNCATED AT 250 WORDS)
The goal of this study was to identify factors associated with six- and 12-month retention in methadone maintenance treatment programs (MMTPs) in Massachusetts and Connecticut. Data was obtained from 674 participants, clinic records, and clinic staff. Ethnographic and logistic regression analyses were conducted. Overall, 69% and 48% of the clients remained in treatment at six months and 12 months, respectively. The MMTPs were categorized as either a 12-Step, case management, or primary care model. Factors independently associated with retention in treatment at six months were each one-year increase in age of client (OR 1.05), injecting at three months (OR 0.47), and enrollment in the primary care model (OR 2.10). The same factors were associated with 12-month retention in treatment. To retain clients in MMTPs-which should, in turn, help reduce drug use and prevent HIV transmission among IDUs-younger IDUs and clients still injecting at three months after entering drug treatment may need additional services from the staff, or alternative treatment regimens. MMTP directors should consider differences between these programs and, if appropriate, make changes to increase retention in treatment.
An ongoing study of interventions designed to increase nontraditional social supports among women at high risk for HIV infection was in the field during the 1992 Los Angeles riot in those neighborhoods most affected by the urban unrest. Using data from structured interviews, the psychosocial characteristics, drug abuse patterns, and distress levels among the women who were recruited for the project in the six months before and after the riot were examined. While substance abuse levels among participants did not increase or decrease as a function of the riot, there were a smaller number of social supports and marginally greater levels of already high psychological distress. Women in the community specifically mentioned a lack of social supports from counselors available in affected areas after the riot. An ethnographic analysis discusses the experience of the participants in the community during the same period of time. Problems in social supports are pointed out. The results are discussed in terms of a general theory of service provision by increasing nontraditional social supports, especially immediately after a major cataclysm.
This article is a report on different methods of estimation of the number of injection drug users (IDUs) in the Boston standard metropolitan statistical area (SMSA) in 1993. Because the sharing of needles is a means of transmission for HIV, an estimate of the prevalence of injection drug use is essential for acquired immunodeficiency syndrome (AIDS) prevention programs. The data for this study come from the Massachusetts Department of Public Health Bureau of Substance Abuse, the Massachusetts AIDS Surveillance Unit, the Drug Abuse Warning Network (DAWN), the National Household Survey on Drug Abuse: Population Estimates 1993, and the Massachusetts State Police Crime Reporting Unit. The estimates in this study can be assessed with regard to the different time frames that are involved, noting that some estimates are useful only to establish upper or lower bounds. The estimate that best meshes with the findings of this report is that there were between 13,500-16,500 injection drug users in greater Boston and 45,000-60,000 IDUs in Massachusetts in 1993.
The characteristics of coca products use in São Paulo, Brazil during the years of 1994 and 1999 were investigated through interviews with 26 key informants (KIs; persons with knowledge of coca product users) in each of these years. The following information was yielded by the KIs: (1) there has been a large increase in coca products use in São Paulo from 1994 to 1999; concomitantly, there has been a decrease of hydrochloride use; (2) the increase has occurred due to the dissemination of crack which became cheap and easily available; (3) reasons for crack use changed greatly: in 1994, use was attributed mostly to pleasurable sensations produced by smoking; in 1999, use was intended to overcome compulsion/dependence or to put up with frustration/family conflicts; (4) crack users in 1999 came from practically all social classes of São Paulo; (5) use of alcohol and/or marijuana to cut down the anxiety and excitement produced by crack increased from 1994 to 1999; (6) even when police repression of traffic was effective, which rarely occurred, it affected only the price of coca products; (7) treatment services available were considered insufficient both in number and quality, and were run by ill-trained health professionals (this situation deteriorated even more in 1999); (8) many KIs heavily criticized the prevention programs because of the use of "scare techniques"; and (9) all KIs in 1999 believed that, unless the government changes its policy toward the drug problem, the situation would become worse in the next few years.
The patient-reported toxicity of an overdose of intravenous methamphetamine is described. The authors report the case of a 34-year old man who inadvertently injected himself with approximately 2.3 grams of methamphetamine. The patient reported disorientation, hallucinations, hyperthermia, photophobia, orthostasis and extreme ataxia. He recovered in seven days without apparent sequelae. The case demonstrates the unusual, temporary neurophysiologic consequences of high-dose intravenous methamphetamine.
There are many indicators that substance abuse research and treatment are going to become better integrated. Hopefully, this development will produce new treatment options and will improve access and effectiveness of care. Among the most significant factors in this period of change are the advances in addiction pharmacotherapy. For the treatment of alcoholism, disulfiram has been joined by naltrexone, and soon acamprosate will be added to the list of available pharmacotherapies. Individuals with opiate dependence who, for 25 years, were limited to a single medication (methadone) now have LAAM as an available treatment. Furthermore, there is eager anticipation that buprenorphine/naloxone will bring many more opiate users into treatment since it appears that this medication will be available to doctors outside the traditional narcotics treatment program settings. Other opiate addiction treatment options, including sustained-release naltrexone and lofexidine, are in active development. The greatest area of challenge for pharmacotherapy research is the search for stimulant addiction medications. NIDA has extensive efforts underway to discover/develop medicines that can help in the treatment of cocaine and methamphetamine users. During the next decade, those who embrace these new treatments and integrate them into standard care will offer their patients the best chance for recovery.
Inner-city relationships face numerous challenges including illegal drug use and its consequences. The nature of this challenge, however, has changed dramatically with a shift from the crack subculture of the 1980s and early 1990s to the subsequent marijuana/blunts subculture. This study presents data concerning 95 inner-city relationships where illegal drug use was present from people who were interviewed in 2004-2006 and reinterviewed in 2008. Hard drug use was still problematic in the 2000s even with the passing of the crack epidemic and its associated behavioral norms. Hard drug (primarily crack) users reported drug use was a problem, reported conflict over drugs, reported higher levels of conflict than others and were the most likely to have broken up with their partner. On the other hand, the experiences and subcultural norms associated with marijuana use appeared to be much less detrimental to relationship harmony. Subjects who used marijuana but not hard drugs reported much less relationship conflict. Indeed, many reported that they enjoyed using marijuana with their partner. These subcultural insights further the understanding that young adults have constructed a much more socially productive subculture regarding marijuana use than their predecessors had constructed around use of crack.
Drug use trends for people entering county-funded treatment programs from 2001 through 2005 were investigated. The sample was drawn from outpatient counseling, residential treatment, and daycare habilitative programs. Findings center on the rising number of admissions to treatment programs for primary methamphetamine (MA) use, with a focus on participant gender, age, and race/ethnicity. Additional participant characteristics, such as referral source, employment, housing, and health status were also briefly explored. This investigation found that the percentage of admissions to treatment programs for primary MA use has substantially increased in Los Angeles County each year from 2001 through 2005. The groups most affected were young people of Asian, Latino, Native American, and White descent. Additionally, it was determined that women were more likely to enter treatment for primary MA use (relative to other drugs) than were males. National implications of these findings, their limitations, and directions for future research are discussed.
San Diego County, California, is a major distribution center for methamphetamine entering the U.S. from Mexico. All available indicators suggest that the use and abuse of methamphetamine increased between 2001 and 2005. Drug treatment admissions for primary methamphetamine use accounted for 49% of all drug treatment admissions in 2005, up from 37% in 2001, with trends showing smaller proportions of female and Hispanic users and a larger proportion of methamphetamine smokers (vs. inhalation or injection). Increases in prevalence of methamphetamine use were documented among arrestees as well; by 2005, 51% of female and 21% of juvenile arrestees tested positive for methamphetamine. The proportion of emergency department visits involving illicit drugs in which methamphetamine was reported increased from 32% in 2004 to 40% in 2005, although this change was not statistically significant, and methamphetamine-related deaths increased 48% between 2001 and 2005. Data from non-federal drug seizures in San Diego County documented an increase from 21% of all drug items analyzed in 2001 to 32% in 2005. In summary, methamphetamine remains the drug of utmost concern in San Diego. The availability of multiple data sources is imperative for constructing valid characterizations of trends in methamphetamine use and abuse and its affect on health.
Substance abuse among adolescents and adults continues to be a major public health concern. Given the prevalence of substance use, abuse, and dependence in the United States, the treatment needs of the population who abuse substances are great. Adolescents and adults who abuse substances need competent, knowledgeable, and qualified staff to provide services to meet their treatment needs. However, providers of substance abuse treatment services are varied, ranging from those who have minimal formal training to those who have specialized degrees and credentials in the field. In addition, substance abuse professionals represent a variety of fields (social work, psychiatry, psychology, etc) as opposed to a single unifying discipline. Few studies have been conducted examining the background, qualifications, and professional development needs of treatment staff. This article represents an attempt to lay the groundwork for future research. It summarizes information on staff demographics, level of competency, training, recruitment, and retention. In addition, recommendations are made for the advancement of research.
The increase in recreational use of ketamine in France led to the carrying out of a survey aimed at depicting the sociological profiles of French ketamine users, their addictive behaviors, and the characteristics relevant to the use of the substance. This survey is based upon the analysis of 250 questionnaires, 24 semi-directive interviews, and two focus groups. Data was collected between July 2002 and June 2003 among individuals who had used ketamine at least once since January 1, 2001. The respondents were mostly males with a polydrug addiction, aged about 24, with little post-secondary education and no steady job. Ketamine was generally the last substance experimented with throughout their lifetime, as of the age of 22. The article reviews the frequency of ketamine use observed in the population surveyed, as well as the routes of administration, the quantities used, the circumstances of use, the sought-after effects and those experienced, and the risks perceived by the users themselves. The data collected provides working facts to allow for the development and implementation of policies for preventing the use and abuse of ketamine among vulnerable populations.
California Substance Abuse Research Consortium (SARC) meetings have become a mainstay in supporting alcohol and other drug (AOD) information exchange on research to policy and other initiatives within the state. One integral component of SARC is discussion of regional data on emerging and changing substance abuse trends. This article provides highlights from the substance abuse epidemiology portion of the May 2003 meeting, as presented for the San Francisco Bay Area, Fresno County, Los Angeles County, and San Diego County.
The April, 2003 meeting of the Commission on Narcotic Drugs, and the meetings and other efforts to influence it sponsored by interested parties before and around the Commission meeting, are described and analyzed. The 2003 meeting was seen as significant because it was the occasion for assessments of progress on the process goals set out in the United National General Assembly Special Session on drugs in 1998. Debate and discussion of the text of resolutions in the Commission meetings are analyzed in terms of the major points of conflict in 2003 between national delegations--cannabis policies, harm reduction, substitution therapy, and preferences for dramatizing or matter-of-fact language. Also discussed are the drift toward a crime rubric for the drug control system, and the increasing distance between the focus of the system on policing and the focus of most Western European governments on drugs as welfare or health issues. It is concluded that the system seems to be at a stalemate.
California Substance Abuse Research Consortium (SARC) meetings have become a mainstay in supporting the exchange of new alcohol and other drug information on research to policy and other initiatives throughout the state. A cornerstone of SARC is a discussion of regional substance abuse patterns and trends. This article provides readers with a brief overview of recently released methamphetamine statistics, as well as a more detailed review of the methamphetamine information presented during the substance abuse epidemiology portion of the September 2005 meeting, as presented for Kern County, Los Angeles County, San Diego County, the San Francisco Bay Area, and the state of California.
Since the early twentieth century, both moral perspectives and changing perceptions of the disease model of alcoholism and addiction have significantly influenced the formulation of U.S. domestic policy on drugs and alcohol. Some fluctuations have occurred in federal drug policy but overall a prohibitive, punitive approach has been emphasised. Racial and socioeconomic disparities have been exacerbated by the inequities of drug laws. Over the past 50 years, limited progress has been made in challenging and changing these unproductive policies. A great deal of progress has been made in research and treatment, and in the understanding of the process of recovery. For the upcoming generation to move policy in the direction shown to be effective by experienced addiction professionals will entail a wide spectrum of interdependent actions in substance abuse research, education, prevention and treatment, and continued cooperation between many stakeholders.
Although some practices clearly have stronger supporting evidence than others, a single authoritative list of evidence-based practices (EBPs) that can be applied in the treatment of criminal justice clients does not exist. Nationally, use of EBPs is low, and such practices are generally only implemented under certain circumstances. To clarify these issues, experts from around the nation were invited to California for two research-to-policy meetings focused on EBP identification and implementation. Their presentations and the resulting series of articles in this special theme issue describe the current state of EBP research for criminal justice clients. To advance the field beyond the compilation of EBP lists, which can only represent a partial solution at best, next steps should include a greater focus on quality of implementation, intensity of quality assurance and monitoring, and training for underlying skills and principles.
The author describes the scope of California's Proposition 215 and explains the legal and scientific controversies that surround its enactment. The federal government's response to the law (including its threats to any physicians who might recommend medical marijuana to patients) and the litigation that ensued are outlined. The author recounts the complicated role played by the California Medical Association during this time, as it sought to adhere to the principles of the scientific process while also attempting to resist improper governmental intrusion into the physician-patient relationship. The legal impact of the federal Controlled Substances Act on the availability of marijuana for either research or therapeutic purposes is described. The conflict between Proposition 215 and federal law is explained, and author offers a legal analysis of the extent to which physicians have free speech rights under the federal constitution to discuss and recommend the medical use of marijuana to patients. The California Medical Association's efforts to address and reconcile the competing interests, culminating in written legal guidelines for physicians, are described in detail.
Previous studies indicate that buprenorphine has efficacy in medically supervised opioid withdrawal, but the optimal dosing for maximum tolerability and ease of administration remains undetermined. Five heroin-dependent individuals entered this open-label study of inpatient detoxification with a single 24 mg dose of buprenorphine. The mean Clinical Opiate Withdrawal Scale (COWS) score prior to buprenorphine administration was 17.6 (SD = 3.36). COWS scores declined significantly thereafter. There was one episode of precipitated withdrawal that resolved within four hours. Use of ancillary medications was minimal. This study suggests that a single high dose of buprenorphine can be used safely and effectively for inpatient detoxification.
Abstract A new class of synthetic hallucinogens called NBOMe has emerged, and reports of adverse effects are beginning to appear. We report on a case of a suicide attempt after LSD ingestion which was analytically determined to be 25I-NBOMe instead. Clinicians need to have a high index of suspicion for possible NBOMe ingestion in patients reporting the recent use of LSD or other hallucinogens.
Carbon-14 (14C) dating from mummies of the Alto Ramirez culture confirms that coca leaf chewing was an incipient practice among members of a population that peopled the valleys and coastal areas of Northern Chile by 3,000 years before the present (yr.B.P.). Out of eleven bodies from the burial site of Pisagua-7 (PSG-7, S 19 degrees 35', W 70 degrees 13') that were analyzed, two samples tested positive. Mummy 725-A C2 (dated 3,090 to 2,850 two sigma calibrated 14C years before the present) was shown to have a cocaine value of 13.3 nanograms/10 milligrams of sample (ng/10mg), and mummy 741 (2,890 to 2,760 two sigma cal yr B.P.), a 5.6 ng/10mg value.
Typical scenarios of drug-facilitated sexual assaults usually involve victims having ingested a drink after which they had little, partial or no recollection of events for a period of time. We were surprised by the case of a woman who was sexually assaulted and described a state of amazement, leading to an incapacity to resist physically or verbally to her aggressor, and who remembered everything. Alcohol was first suspected but toxicological analysis revealed the presence of 3,4-methylene-dioxy-methylamphetamine (MDMA, Ecstasy). In the literature review, a few cases of sexual assault involving involuntarily MDMA intake are described.
Methamphetamine use is an increasingly serious public health problem in California and other parts of the country. Despite sensationalistic media attention, however, very little is known about users of this clandestinely consumed drug. Employing methods known as Rapid Assessment and Response, the authors describe the epidemiology and public health implications of methamphetamine use in California's Central Valley, with a focus on Sacramento, which many social indicators suggest has been more severely affected by methamphetamine than any city in the nation. Data sources for this report include interviews with drug users, statistical reports, epidemiologic studies, and local informed expert opinion. In their social demography, methamphetamine users in the Central Valley are in marked contrast to those of coastal cities such as Seattle and San Francisco, being largely heterosexual, and of mixed racial/ethnic heritage. Three-quarters or more initiate their use of the drug while still in their teens, with more than a quarter beginning use before the age of 15. Many of these rapidly gravitate to regular use, and continue using well into their thirties. Methamphetamine users are at much higher risk of infection with HIV than opiate users, particularly if they inject. Partly because methamphetamine enhances libido, users of the drug typically also have many more sexual partners. Not surprisingly, data indicate that methamphetamine users are more likely than heroin users to be HIV-infected. Methamphetamine appears to be less of a street drug than heroin, complicating efforts at street outreach. However, because it is typically used in social settings, a social or diffusion approach to HIV prevention might be particularly promising.
The medicinal use of cannabis is a growing phenomenon in the U.S. predicated on the success of overcoming specific spatial challenges and establishing particular human-environment relationships. This article takes a medical geographic "snapshot" of an urban site in Washington State where qualifying chronically ill and debilitated patients are delivered locally produced botanical cannabis for medical use. Using interview, survey, and observation, this medical geographic research project collected information on the social space of the particular delivery site and tracked the production cost, reach, and health value of a 32-ounce batch of strain-specific medical cannabis named "Plum" dispensed over a four-day period. A convenience sample of 37 qualifying patients delivered this batch of cannabis botanical medicine was recruited and prospectively studied with survey instruments. Results provide insight into patients' self-rated health, human-plant relationships, and travel-to-clinic distances. An overall systematic geographic understanding of the medical cannabis delivery system gives a grounded understanding of the lengths that patients and care providers go, despite multiple hurdles, to receive and deliver treatment with botanical cannabis that relieves diverse symptoms and improves health-related quality-of-life.
This study is a long-term follow-up to the Concord Prison Experiment, one of the best-known studies in the psychedelic psychotherapy literature. The Concord Prison Experiment was conducted from 1961 to 1963 by a team of researchers at Harvard University under the direction of Timothy Leary. The original study involved the administration of psilocybin-assisted group psychotherapy to 32 prisoners in an effort to reduce recidivism rates. This follow-up study involved a search through the state and federal criminal justice system records of 21 of the original 32 subjects, as well as personal interviews with two of the subjects and three of the researchers: Timothy Leary, Ralph Metzner and Gunther Weil. The results of the follow-up study indicate that published claims of a treatment effect were erroneous. This follow-up study supports the emphasis in the original reports on the necessity of embedding psilocybin-assisted psychotherapy with inmates within a comprehensive treatment plan that includes post-release, nondrug group support programs. Despite substantial efforts by the experimental team to provide post-release support, these services were not made sufficiently available to the subjects in this study. Whether a new program of psilocybin-assisted group psychotherapy and post-release programs would significantly reduce recidivism rates is an empirical question that deserves to be addressed within the context of a new experiment.
This study examines the utility of several process-of-care performance measures (initiation, engagement, retention, and monitoring of drug use during treatment) as predictors of methamphetamine (MA) use outcomes at 12- and 36-month follow-ups. MA-dependent individuals (n = 871) participated in a randomized, controlled trial of outpatient psychosocial treatment from 1999-2002 and completed 12- and 36-month follow-up interviews. This sample included a treatment-as-usual group (n = 436) and a 16-week Matrix treatment (n = 435) group. Significant associations were observed between select process-of-care measures and MA use outcomes at both follow-ups. While correlational analyses showed an association between MA abstinence at follow-up and enhanced treatment engagement and retention, mixed logistic regression analyses indicated that sustained abstinence from MA during outpatient treatment was the strongest predictor of testing negative for MA use at both follow-ups. Results suggest that monitoring client drug use during treatment may be a useful process-of-care measure with MA-dependent users.
In California, Proposition 36 (Prop. 36) has led to positive outcomes for a significant proportion of participants-increases in drug treatment completion, reduced drug use and recidivism, and increased employment. However, there are notable differences in outcomes among Prop. 36 subgroups, with some of the poorest outcomes observed among opioid users. This may be because very few Prop. 36 opioid users were placed in narcotic treatment programs (NTPs). Prop. 36 opioid users who were placed in NTPs using methadone had the greatest reductions in opioid use from treatment intake to discharge, as compared to Prop. 36 opioid users who received outpatient drug-free or residential treatment. As such, NTPs should be considered to be a highly efficacious and viable treatment option for Prop. 36 opioid users. Thus, to improve treatment outcomes among Prop. 36 opioid users, it is essential that the provision and utilization of NTPs be enhanced.
This article examines key differences emerging in implementation of California's Proposition 36 voter initiative across eight diverse large, medium, and small counties. The data were collected in 2001 in a key informant survey of county policymakers. Unlike most major California criminal justice initiatives of recent years, Proposition 36 represents a potential lessening of adjudicatory and penal controls rather than an increase in their severity, in this case in response to charges of drug use, possession, or transportation. Furthermore, Proposition 36 was written broadly enough to allow considerable discretion in implementation across the counties, including the specification of funding to support mandated provisions of the Act and division of oversight responsibilities among criminal justice and treatment stakeholders. Hence actual content and scope of criminal justice system procedural changes, and impact of the proposition on criminal justice and treatment systems and on arrestees, are likely to vary by county. The article identifies key approaches and decisions made in the sampled counties that are predicted to affect the proposition's impact in the areas of treatment versus criminal justice resources, prosecutorial implementation, defendant and defense responses, assessing criminal histories and treatment needs, treatment versus criminal justice supervisory responsibility, and procedural variations and client behavior.
Methamphetamine (meth) is a major drug of abuse in California and several other states, particularly among criminal offender populations. Over the past decade, substance abuse treatment systems have had to adapt to and accommodate the increasing needs of meth users and, in California, deal with the impact of Proposition 36, which has resulted in a greater number of criminal offenders entering the treatment system. This study examines selected treatment performance and outcome indicators for California Proposition 36 offenders entering substance abuse treatment for meth use and compares their performance and outcomes to other subgroups of California treatment clients differentiated by whether or not they were admitted to treatment through Proposition 36 and whether or not their primary substance was meth. Significant improvements in all outcome domains were seen across the populations, and treatment performance and outcomes were not substantively inferior for the offender or meth-using groups.
Methamphetamine (MA) use is considered as one of the nation's most pressing drug problems. In California, MA use has outstripped all other drugs in epidemiological extent, law enforcement activities, and treatment services demand. An opportunity for further study of MA use and its treatment emerged from a change in offender sentencing options introduced by California's Substance Abuse and Crime Prevention Act of 2000 (SACPA). Results indicate that statewide admissions for MA rose from 8.4% in FY 1992/1993 to 34.6% in FY 2004/2005, a four-fold increase over the 13 years. From the year before SACPA implementation to the year after, the percentage of treatment admissions due to MA use increased from 18.8% to 25.6%, an increase largely due to the fact that SACPA admissions were over 50% MA users. With the exception of alcohol, MA users entering treatment through SACPA had higher completion rates (about one third) from community based treatment than users of other primary drugs. This result held true for demographic and other subgroups of MA users. Multivariate regression results illuminate the relative importance of the variables examined. Implication of the findings for policy, intervention services, and research are discussed.
This article must be considered a work-in-progress. The California Society of Addiction Medicine seeks to briefly enumerate some guiding principles for initial consideration. It is the Society's hope that the issues presented here can promote further discussion and planning in collaboration with our colleagues in the criminal justice system, the community of California treatment providers, and other social service agencies, and in future consultations with experts at the National Institutes of Health and other relevant research and treatment agencies in California, Washington, and elsewhere.
The Prevention Panel of the Therapeutic Jurisprudence conference presented several examples of community services and prevention policies that should be brought into the mix of services and supports for Prop 36 and for other court diversion programs. This article summarizes those presentations and suggests how they might be put to work as effective alternatives to incarceration.
The initiation of the first methadone maintenance treatment program (MMT) in Macao was founded in collaboration between MMT clinics in the USA and Israel. All patients admitted into treatment between October 2005 and October 2008 were prospectively followed through March 2010. Of the 163 patients, 81% were male, the mean age on admission was 39.5 (sd = 10.2). Seventy-three percent (n = 119) were hepatitis C sera positive, and 4.9% (n = 8) were HIV sera positive. One-year treatment retention rate was 59.5%, with 52.6% of the 95 patients who stayed in treatment having an opiate-negative urine test at the 10-month evaluation. Four and a half years of follow-up showed mean long-term retention (Kaplan Meier analyses) of 2.2 years. Higher methadone dose (> or = 80 mg/day) and hepatitis C sera positive status were predictors for longer treatment retention. This study describes an effective model of MMT that supports the expansion of addiction treatment in other countries.