Sunday, October 12, 2014

Banning club drugs hasn't made users safer

vox


A grieving mom hopes her plan will

by Mona Lalwani on October 3, 2014

Dede Goldsmith was asleep in a Kentucky hotel room, on the last night of a three-week trip with her husband, when her phone rang. It was 2:15 a.m. "I'm really sorry, Mrs. Goldsmith," a voice on the other end said. "Shelley has been taken to the hospital."
Shelley was her 19-year-old daughter. A student at the University of Virginia, she had taken a trip with her friends to see Dada Life, a Swedish electro-house duo, at a Washington, DC, club. At the concert, Shelley wasn't feeling well. She went to the bar for water. "Call 911," she said, before she collapsed.
"Her friend kept saying 'sorry,' like she was already gone," Goldsmith said later of the phone call. The friend told her that Shelley had taken Molly that night.
"Who's Molly?" Goldsmith asked.
Earlier that evening, August 30, 2013, Shelley had boarded a rented party bus, complete with couches and booming electronic dance music, to make the 120-mile trip from Charlottesville, Virginia, to the concert. Thirty-four University of Virginia students were on board. Almost everyone took a hit of Molly.
Molly is a powdered psychoactive that is supposed to be the purest, uncut form of the drug MDMA, often called ecstasy when it is in pill form. The high brings on a sense of euphoria and empathy. It stimulates the senses in a way that complements the immersive spectacle of an electronic dance music show.
"My heart says: if you're gonna try Molly, you better make sure you know what you're taking"
"Essentially everyone on that bus was on the drug," said Kate, one of the students on the bus. ("Kate" asked not to be identified by name.) "We got to the concert and everyone was having an amazing time."
Shelley had taken some Molly on the bus, and then another hit at the club. When she collapsed, most of her friends assumed she had passed out from dehydration. They headed back home on the bus thinking she would be fine. Her boyfriend and a close friend stayed back, going with Shelley by ambulance to Providence Hospital, where doctors attempted to revive her.
"The next day, we heard she was in a coma and then, her liver was shutting down," said Kate. "The news got progressively worse."
The Goldsmiths were a nine-hour drive away from the hospital in Washington, D.C. As they drove, Dede prayed, "God, don't let this happen." She looked up at the sky and saw a crescent moon alongside Venus. Then clouds covered the sky, only to part for a moment, displaying stars and moon again, before taking them completely out of sight. "I knew it in my heart, it was the sign I needed," she said. She knew then she was going to lose her daughter. She started to get sick. They pulled over multiple times on the drive; her stomach was "torn to pieces." They reached the hospital around 11:30 that morning. "It was a horrible, horrible scene. They had her on a ventilator," Dede Goldsmith said. "She never acknowledged our presence."
Nicolas, Shelley's 34-year-old brother, told her, "Come on Shell, you can do it." There was no response.
Her mother believes the doctors made extraordinary efforts to revive Shelley. Nevertheless, her organs failed one by one. At 7:30 p.m., the doctors took her off the ventilator.
For months after her daughter's death, Goldsmith wondered if things could have turned out differently. "Shelley didn't know what she was taking," she said. "This is a girl who had done her laundry, picked up her dry cleaning, before going to the concert. She was not frivolous in any facet of her life."
In her quest for answers, Goldsmith came to a startling realization: Molly didn't kill her daughter. Federal policies that promote drug abolition and discourage education about safe drug use killed her daughter.
"The way we deal with it has got to change because people are dying," said Goldsmith. "My heart says: if you're gonna try Molly, you better make sure you know what you're taking."

Over the last decade, the underground, unregulated raves of the ‘90s have slowly been replaced by an organized electronic dance music industry that thrives at weekend music festivals. With recent stage productions befitting blockbusters, the experience is more like a Broadway musical than a street play. The synchronicity of beats, lasers, and fireworks is meticulously planned. Tens of thousands of fans gather around a stage to celebrate their favorite DJs. They know when to bounce and sing in unison and when to raise their hands. The audience's apparel is a rainbow of neon colors: bright tutus, furry boots, floral headgear, and beaded bracelets.
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Earlier this year, Ultra Music Festival in Miami saw more than 150,000 visitors, according to the show's promoters. Despite a drug-related death in 2010, Electric Daisy Carnival continues to host an average of 300,000 festival-goers in Las Vegas every year. And it's not just in the United States. Tomorrowland turns Boom, a small town in Belgium, into the biggest dance floor in Europe, with close to 180,000 attendees. It's said to draw more nationalities than the Olympics.
These festivals have become synonymous with the use of MDMA — a drug that is packaged with a promise of bliss. "It's, like, amazing. Anybody who has tried it knows it's the most alive you've ever been-times a million," said Kate.
The popularity of MDMA and its counterparts has soared. According to theNational Survey on Drug Use and Health, in 2012 more than 1.3 million people ages 18 to 20, and 3 million people ages 21 to 25, said they had used ecstasy at least once in their lives. For a sense of how much ecstasy is on the market: more than 15 million pills were seized in 2010, according to the Department of Justice.
The popularity of the drug also underscores the dangers associated with it. According to Substance Abuse and Mental Health Services Administration, among people 20 and younger there were 4,460 ecstasy-related hospital emergency visits in 2005, and 10,176 in 2011 — an increase of 128 percent. Some cases have also been fatal. A 19-year-old died at a dance music event in Boston last summer. And on the same weekend that Shelley Goldsmith died last year, two young attendees died at Electric Zoo, New York's premier dance music festival. The festival was shuttered on its third day.
The current approach to reducing the number of injuries and deaths related to MDMA is complete abolition of drugs at concerts and raves. A 2003 law called the Illicit Drug Anti-Proliferation Act (popularly known as the RAVE Act), in effect, holds venue owners and promoters responsible for drug use at their events. Promoters cannot offer services that provide information for safe drug use, as that might be mistaken for endorsement of drugs. To obtain permits and insurance for large gatherings, promoters enforce a zero-tolerance drug policy. They set up security checks in conjunction with local police for pat-downs and bag checks. (Read more about the RAVE Act and its consequences.)
Robert DuPont, first director of National Institute on Drug Abuse and a former White House drug czar, believes this is the right strategy. "These drugs are illegal for a reason," he said. "They're dangerous."
But some health advocates believe that the best way to reduce the dangers of club drugs is to help people use them safely. Death by overdose on pure MDMA is "highly unlikely," according to Emanuel Sferios, founder of DanceSafe, a nonprofit that promotes health and safety at electronic dance music gatherings. The vast majority of adverse reactions are from undetected substances like MDA (methylenedioxyamphetamine), methamphetamine (commonly called speed), caffeine, or Ketamine that are often found in varying quantities in ecstasy or Molly. Still, the setting in which the drug is often consumed — outdoor summer festivals and cramped nightclubs — can make even pure MDMA dangerous. "It inhibits the body's ability to maintain its temperature," said Sferios.
This is what happened to Shelly Goldsmith. Her 14-page toxicology report, which took three months to complete, showed no traces of adulterants, alcohol, or marijuana. She died, it said, of a massive cardiac arrest from MDMA intoxication. The drug, combined with heavy activity, like dancing, in a hot environment, led to hyperthermia — heat stroke.
DanceSafe wants to provide drug checking at dance music events, but promoters won't allow it
"No drug use is 100 percent safe," said Sferios. Still, DanceSafe tries to make drug use safer by offering free water, information cards, and judgement-free conversations. Their efforts, funded by donors, are aimed at minimizing harm associated with drug use. Their most radical technique is a checking service that allows people to see if their drugs have dangerous additives in them. Users mix a small portion of the drug with a chemical compound, and if it turns a certain color, they know the drug is impure. DanceSafe offers these ecstasy-checking kits online for home use. They would like to provide on-site drug checking at dance music events, but promoters won't allow it.
"I empathize with the promoters," said Missi Wooldridge, the executive director of DanceSafe. "Because of this drug war and policy, they're scared to address drug use pragmatically. They're fearful of the legal implications. A lot of them know and understand the community. But their hands are tied."
Health educators believe that festival-goers should receive information about how much time it takes for effects of a drug to set in and how long those effects are expected to last, along with potential risks from usage. This information can prevent overdosage and reduce damage, but it's rarely made available at dance music events. For instance, at Electric Zoo this year, education was limited to a video about club drugs that every ticket holder had to watch to activate their digital entry bracelets. The public service announcement had the potential to be a public safety initiative. But instead the video perpetuated misconceptions about the drug and the people who use it.
The video shows a young man dancing, sweating profusely, and rubbing a white powder on his gums. He slurs through words like "rolling" (slang for being high on MDMA) and "sick beats" as a girl attempts to talk to him. She eventually walks away, leaving him delirious from the exaggerated effects of a drug. This missed the opportunity to provide information to a large number of attendees on how to stay safe when intoxicated.

Europe takes a much different approach to drug use at concerts. "We put our heads in the sand and pretend it's not happening," Sferios said. In Europe, on the other hand, "they come at it from a different perspective: public safety."
In Amsterdam, for instance, authorities try to provide a safe zone for users, both recreational and addicted.The relationship between the public and the local authorities resembles a progressive child-parent relationship. In order to ensure well-being and an open line of communication, the government acknowledges the existence of drug use.
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Unity, a Dutch organization that provides safety tips on alcohol and drugs, has a team of trained volunteer drug and health educators. Unity is fully funded by Amsterdam's city council and is present at all major electronic dance music events, like Awakenings and Mysteryland.
"The health of the drug users is the priority in Amsterdam," said Judith Noijen, who runs Unity. Apart from medical setups that are equipped for drug-related questions and cases, a temperature-controlled area and free water are essentials at Dutch parties. Fruits are also offered: the natural sugar and vitamins is said to replenish the loss of energy and neutralize damage. "Drug use is not illegal — dealing or importing drugs is illegal," Noijen said. "The reason is, they think, 'if we start hunting users down, we create a taboo.' That's not what we want."
On a damp Friday evening in Amsterdam, Unity volunteers gathered at Gashouder, a prominent disc-shaped building in Westergasfabriek Culture Park known for hosting dance music parties. Inside, an hour later, a couple of thousand people bounced to the beats of techno in a laser-lit arena.
The volunteers, including 26-year-old Jochem Driessen, worked to set up their corner in the "chill area," designated for breaks on a night that would include drug use and dancing. Candy, vitamins, and omega-3 oil capsules were set out in bowls. Surveys and information cards about drugs including ecstasy (or XTC as the Dutch like to call it), cocaine, and ketamine were set out, both in Dutch and in English.
"The first time I saw Unity at a party, they gave me information I didn't have before," said Driessen. In a white t-shirt, a red zip-up hoodie, and jeans, he was an unassuming powerhouse of drug knowledge. "I think that a lot of accidents can be prevented concerning drugs — and a lot of people are very happy to get that information."
A basic foundation is first established in high school. "They don't say, 'If you use ecstasy, you will be addicted'," said Driessen. By relaying both the realistic effects and dangers of drugs, young people are allowed to make an informed choice. "From then on, you know the difference between ecstasy and heroin. So, people who are better educated are more careful."
Driessen sees a connection between dance music culture and ecstasy, and believes it has to do with the nature of the music. "The bass goes on and on in the same motion. Ecstasy can get you hooked onto the motion," he said. "You start to understand the music more." But this combination is not unique. "At rock concerts people will drink shit loads of alcohol. Then what are you gonna do, ban all parties? That's not a solution."
Through the night, the crowd consciously switched between dancing and taking breaks. Volunteers got visitors chatting like kids on a playground. With lollipops tucked under their tongues, they discussed their favorite drugs instead of their favorite superheroes.
While conversations are encouraged, on-site drug checking is banned by Dutch promoters. But the service is also largely unnecessary. Users can use the two official drug-checking centers in the city — which run to maximum capacity. On an average, about 35 people show up when the service opens for four hours every Thursday, according to the group that runs the center. Off-site drug checking requires a certain discipline. Results can take up to a week, and sometimes people wait for a couple of hours to drop off their samples. Still, drug checking is a well-established practice. The service, across 23 centers in the Netherlands, handles about ten thousand samples every year.
Amsterdam is often perceived as a vast ocean of hedonistic drug use. In reality, it's more like a carefully watched aquarium. The tank is constantly cleaned; contamination is swiftly flushed out. The checking center is quick to issue a detailed warning when it finds adulterants in drugs. They warn users about the particular batch of a drug and encourage them either to test it or to simply not take it at all. From posters at parties to issuing press releases, no effort is spared. With the support from local authorities, the adulterated drug is wiped off the market within weeks and often never seen again.
Amsterdam gives precedence to health over punishment. Over the years, the city has tried different approaches to drug use before settling for the progressive tactics that emphasize drug information and medical support for users. For instance, in 2008, sniffer dogs and arrests for minimal possession at events briefly replicated America's zero-tolerance policy. "People were not comfortable coming up and talking to us," Noijen said. "They were scared to get arrested at the party. People started telling us they were having the pills before coming to the party, which is bad for their health."
Amsterdam is often perceived as a vast ocean of hedonistic drug use. In reality, it's more like a carefully watched aquarium.
Eventually, the cost of maintaining a steady flow of police at events exceeded the fines that were brought in from charges of possession. "We don't have police at the party anymore," Noijen said. "It creates a better atmosphere. You don't want the situation where people are afraid, especially when they're high. Now other cities are looking at Amsterdam to change their policies, too."
Organizations like Drug Policy Alliance work consistently to bring about those policy changes in the United States. But they have their distinct set of challenges. "Stigmatization is the biggest obstacle," said Stefanie Jones, who works for the Drug Policy Alliance. "We've cut that back a lot from marijuana but for everything else — it's hard to talk about personal use or think about other people using. That's hard to get around when you talk about policy solutions."
Still, public opinion about drugs can change rapidly over time. Opinion on the legality of marijuana has shifted radically: In 1997, 25 percent of Americans polled by Gallup believed it should be legal. By late 2013, 58 percent were in favor of legalization. Like marijuana, MDMA is a drug that millions of people use casually over the weekends or at festivals.

Kate and her friends, including Shelley Goldsmith, were casual users. Death from a heat stroke or possible adulterants in Molly was not even a consideration for them. "What shocked me was that we all thought that this drug was perfectly safe," said Kate. "I remember I took the drug nonchalantly — I took it like a vitamin. There was no moment of anxiety or anything."
At the University of Virginia, some students believed Goldsmith's death was an anomaly; others thought that she was dehydrated or had been drinking, or perhaps that the drug was laced. "They think it was a freak accident — and it wouldn't happen to them," said Kate. A student organization, the Shooting Star Foundation, has been created since Goldsmith's death to provide accurate drug information at the university. But the students need more than good intentions to provide it to their peers.
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In schools across the United States, scare tactics are often disguised as drug education. DARE, the Drug Abuse Resistance Education program founded in the 1980s, for instance, "is called the scared straight program," said Sferios. "Police officers go into school and essentially use scare tactics to make young children afraid of drugs." They relay negative consequences of drug use, consequences that won't necessarily be the case for everyone. "If they're not even saying the most basic truth — it makes you feel good and that's why people do it — why would the youth believe anything authorities have to say about this drug?," he said.
The just-say-no model has proven to be ineffective. Project DARE "has little if any impact on alcohol and drug use," declared a study from the National Institutes of Health. The study concluded that a reformed version of the project, DARE Plus, which encouraged peer and parental education, was more effective than the original project. But its benefits were restricted to containing aggression and alcohol use among adolescent boys. The underlying intolerance for drugs and failure to address drug use remain unchanged.
Even so, DARE continues to be used in 75 percent of the country's school districts.
Spurred in part by recent MDMA-related deaths, educators and users are beginning to talk about drugs differently. "It's almost like a coming out process," Jones said. "People have to talk about their experiences with the drugs."
Shelley Goldsmith's friends say she was not a "druggie." "I would be fine with not rolling tonight," she texted a friend the day she died. She was a Jefferson Scholar, UVa's highest merit awarded to a student. She never smoked marijuana but chose to give Molly a shot and tried it a couple of times last summer.
"She was such a beautiful girl," said Shelley's mother. She had loved to dance since she was a child. Growing up in southwest Virginia, she embraced the outdoors with hikes through trails and campfires by the lakes. Apart from being an exceptional student, she volunteered for the local food bank and helped raise money for the American Heart Association. Despite small-town prejudice, she started a gay-straight alliance club in high school in support of a close friend. And at 17, she ventured into New York City for a brief summer of modeling. Her friends describe her as someone who was accomplished yet compassionate. From making a breakup survival kit for a hurting friend to planning birthdays, she constantly found ways to support her friends.
"She had a full life. She was the captain of the tennis team, graduated top of her class. She was not your average student," said Dede Goldsmith. "She was destined for greatness."
At a hotel in D.C., Goldsmith was composed and elegant in a floral shirt and olive green sweater. Her thin metal-rimmed glasses did little to hide her eyes — they lit up easily at the mention of her daughter's name, the same way they got moist when she saw Shelley's smiling face on her laptop. "Those first few months were just horrible, it's like getting kicked in the gut," she said. "I don't think you can make sense of it. I'm hopeful that if I don't think about it, it'll go away, but I still wake up crying in the middle of the night."
Over the past year, she has struggled to grasp the exact moments that led to her daughter's death, but something made itself clear: "I started to understand her life had a purpose and I'm part of that purpose."
This summer, Virginia Governor Terry McAuliffe appointed Dede Goldsmith to the Commission on Youth. Working with groups like DanceSafe, Goldsmith hopes to address policy changes that will make room for drug education. She believes youth programs need to address experimentation and recreational use. "We're not dealing with addicts," she said. "They are kids taking a chance occasionally."
Recently, on the first anniversary of her daughter's death, she launched Amend the RAVE Act, a campaign that petitions members of the Congress to rectify the law. The campaign points out that promoters fail to provide measures like educational literature about drug use and temperature-controlled spaces, because they fear prosecution for "maintaining a drug-involved premises," as the current law states. Goldsmith hopes that a clarification of that intent, which is misplaced in an organized dance music industry, will allow promoters to safeguard their patrons and reduce the risk of drug-related emergencies.
"I never expected to be on this side of the issue-acknowledge the fact that kids are doing it," she said. "Get away from saying, 'No, drugs are bad.' That's all good but it doesn't impact the kids who are using drugs at concerts to release stress, have a good time, get an elevated experience, whatever."
In trying to understand the drug that led to her daughter's death, Goldsmith has come to perceive the electronic dance music community and its challenges in a new light. "I want kids to have a good time, but who would've thought parachuting out of an airplane would be safer than going dancing? If they're going to do drugs, they need the information to do it safely."

Wednesday, May 14, 2014

Effective Drugs to Curb Alcoholism Are Ignored, Study Finds

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Two medications could help tens of thousands of alcoholics quit drinking, yet the drugs are rarely prescribed to patients, researchers reported on Tuesday.
The medications, naltrexone and acamprosate, reduce cravings for alcohol by fine-tuning the brain’s chemical reward system. They have been approved for treating alcoholism for over a decade. But questions about their efficacy and a lack of awareness among doctors have resulted in the drugs being underused, the researchers said.
Less than a third of all people with alcohol problems receive treatment of any kind, and fewer than 10 percent are prescribed medications. The Affordable Care Act requires that insurers provide coverage for substance abuse treatments and services, and addiction specialists expect to see increases this year in the number of people seeking help for alcoholism.

Tuesday, May 13, 2014

This Smart Lighter Will Help You Quit Smoking

This Smart Lighter Will Help You Quit Smoking

Quitbit
Similar to fitness trackers, Quitbit monitors smokers as they try to quit.
IMAGE: QUITBIT
A new Internet-connected lighter called Quitbit will light your cigarette, but wean you off a smoking habit too.
A new Kickstarter campaign called Quitbit takes the same monitoring principles embedded into fitness trackers and helps users track and cutdown on smoking. In a nod to the name, it's like a Fitbit for smoking.
The product, which launched on Monday and is seeking $50,000 in funding pledges, is a pocket lighter that uses a heating coil similar to what's found in cars. But whether you're looking to quit or not, the lighter keeps track of every time you light up and logs that data in an accompanying app.
Users can set custom plans — so they can trim on intake at whatever pace they want — and see much money they've saved by cutting back on packs along the way. It also reveals the time since your last smoke, how many were consumed within a certain period of time and lets you call out the times you shared a cigarette with a friend (or let someone borrow the lighter).
The Quitbit, which also works with e-cigarettes or the patch, was developed by two friends who wanted an easy way to track the quitting process.
"Kuji and I were both smokers and met while in grad school together at Brown," co-founder Ata Ghofrani told Mashable
"I was trying to quit when he asked how much I smoked, and I realized there wasn't a really good way to keep track."
"I was trying to quit when he asked how much I smoked, and I realized there wasn't a really good way to keep track." "I was trying to quit when he asked how much I smoked, and I realized there wasn't a really good way to keep track."
Although there are countless apps on the market that help smokers quit, this is the first solution that includes hardware: "We wanted a piece of hardware to automatically monitor how much you're smoking, without having to manually enter that information within the app," he added.
Although it's up to each person to decide when and if they want to quit smoking, keeping the Quitbit in your pocket — we assume — gives the same affect of wearing a fitness wristband tracker. Sure, you might not wear a Fitbit to specifically lose weight, but it serves as a constant reminder to stay active.
The Quitbit will likely do the same; having access to all of your smoking data might the final nudge you need to scale back.
Have something to add to this story? Share it in the comments.

Saturday, May 3, 2014

First U.S. Case of MERS Virus Is Found in Indiana Man Who Visited Mideast

     
A virus that has killed more than 100 people in the Middle East has been found in the United States for the first time, in an Indiana health care worker who recently returned from Saudi Arabia, federal health officials said on Friday.
The man, whose name, age and exact occupation have not been released, is in stable condition in an Indiana hospital.  He is in isolation and receiving oxygen.
A single American case of the virus —called MERS, for Middle East respiratory syndrome — is “a very low risk,” Dr. Schuchat said. The C.D.C. is not recommending that anyone change travel plans to the Middle East.
But a team from the agency will travel to Indiana to assist in treatment and to retrace the patient’s contacts. He flew to Chicago from Riyadh, Saudi Arabia, via London on April 24, then took a bus to Indiana. He fell ill on April 27 and was hospitalized the next day.
The typical incubation period for MERS is five days, and the patient is not known to have infected anyone else. Airline passenger lists will be used to contact everyone who sat near him.
But because bus companies often do not know who bought tickets or who sat where, “that bus ride may be a challenge,” said Tom Skinner, a C.D.C. spokesman.
MERS is a coronavirus similar to SARS, or severe acute respiratory syndrome, which killed hundreds of people, mainly in China, in 2002 and 2003.
The newer virus was first reported in 2012 in Saudi Arabia. Since then, about 400 cases have been reported to the World Health Organization; about a third have been fatal. (The numbers are inexact because of delays in laboratory confirmations.)
The virus is thought to have originated in bats, but it is also widespread in camels. While it has not spread easily between humans, there have been outbreaks within families and in hospitals, where patients have infected paramedics, nurses and doctors.
For unknown reasons, cases began surging in Saudi Arabia in March. Some experts fear that mutations made the virus more transmissible, while others believe that more camels are transmitting it and that carelessness in hospitals has helped it spread.
The classic symptoms are fever and shortness of breath, which indicates pneumonia, but there have been mild cases and unusual symptoms. The W.H.O. suggests that hospitals test any patient who has returned from the Middle East within 14 days.
There have been large recent outbreaks in Saudi Arabia and in Abu Dhabi, United Arab Emirates, and the first case in Egypt was just reported.
There is no cure. Patients may be put on ventilators and given antibiotics to prevent secondary bacterial infections, in the hope that their immune systems will slowly defeat the virus.
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Friday, May 2, 2014

Peaches Geldof Died From A Heroin Overdose

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A sad echo of her mothers passing

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The details of the toxicology report will be officially announced today, but it has been confirmed that Peaches Geldof died of a heroin overdose. The 25-year-old daughter of Sir Bob Geldof was found dead at her country home earlier this month.
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Her 11-month-old son Phaedra was in the home with Peaches when she died. It is a tragedy as her mother Paula Yates also died in similar circumstances, from an accidental heroin overdose in 2000 aged 41.

Thursday, May 1, 2014

Toronto mayor in new crack video scandal


Emergence of footage coincides with Rob Ford's decision to take a leave of absence and seek help for substance abuse.

Two Globe and Mail reporters viewed recently filmed footage of Toronto Mayor Rob Ford once again smoking what appears to be crack cocaine. The video is one of three clips that a self-professed crack and heroin dealer claimed to have shot in the basement of Mr. Ford’s sister’s home. The Globe obtained a series of screen grabs from that footage.

State-Sponsored Horror in Oklahoma





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At 6:36 p.m. on Tuesday in McAlester, Okla., Clayton Lockett started kicking his leg, then twitching, then writhing and moaning in agony, and everyone watching knew something had gone terribly wrong. Mr. Lockett, a convicted murderer, was strapped to a gurney in the death chamber of the Oklahoma State Penitentiary, about to be executed by lethal injection, but the untested combination of a sedative and a paralyzing agent had failed.
an eyewitness account by a reporter for The Tulsa World, Mr. Lockett tried to raise himself up, mumbled the word “man,” and was in obvious pain. Officials hastily closed the blinds on the chamber and told reporters that the execution had been stopped because of a “vein failure.” But at 7:06, the inmate was pronounced dead of a heart attack.
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Statistical study estimates that some 4% of US death-row prisoners are innocent.

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The chances of exoneration increase the longer a person remains on death row, according to a study.
At least one in 25 people on death row in the United States would be exonerated if given enough time, researchers have found. The study, which used statistical methods to extrapolate from available data, is one of the first to try to quantify the rate of false convictions.

Friday, April 25, 2014

Opioid Treatment Among Pregnant Women

New frontier of risk

Study finds sharp rise in opioid treatment among pregnant women

April 23, 2014 | Popular
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A recent study by a group of Harvard-affiliated researchers found a sharp increase in the use of opioid painkillers among a large group of pregnant women between 2000 and 2007.
The increase means that more than one in five women receiving Medicaid — which pays for 40 percent of U.S. births — took codeine, oxycodone, or another opioid sometime during their pregnancy, a troubling trend particularly because opioids have been implicated in potentially fatal birth defects in fetuses.
The research team included scientists and physicians from the Harvard School of Public Health as well as Brigham and Women’s Hospital and Massachusetts General Hospital, both Harvard affiliates.
Rishi Desai, a Harvard Medical School research fellow working in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham, was the lead author. The Gazette talked to him about the research and its implications.
GAZETTE: Your study in Obstetrics and Gynecology revealed some disturbing information on medication use during pregnancy. Can you describe the findings?
DESAI: The main finding of our study was that 21.6 percent of the 1.1 million Medicaid-enrolled pregnant women included in our cohort were exposed to some kind of opioid painkiller during the duration of their pregnancy. In 2000, the overall prescription rate of these medications at any time during pregnancy was 18.5 percent. That went up to 22.8 at the end of 2007, so we saw a sharp rise in a relatively short amount of time. We need to evaluate the fetal safety of these medications because right now we have very limited information, yet their use has been increasing.
GAZETTE: Was that finding expected or unexpected?
DESAI: The magnitude was surprising, but we were expecting to see some rise because several studies have documented a similar trend in the general population. What goes on in the general population is pretty much reflective of any specific subpopulation you study, and pregnant women were our subpopulation of interest.
GAZETTE: Can you tell us a little bit about the medication itself? What is an opioid? What do we know about them and their potential impact on fetuses?
DESAI: Opioids have been around for a long time. These are painkilling medications such as codeine, hydrocodone, and oxycodone. There are many, but those are the ones that are more commonly used. These are controlled substances, which means the FDA has recognized them as being potentially habit-forming. These agents are basically used for pain control in the general population. Pregnancy is one of the conditions in which pain complaints are fairly common, especially back pain and abdominal pain.
One of the reasons we decided to do this study was research published in 2013 that highlighted concerns about the safety of the fetus when this medication is used. That study saw an increase in neural-tube defects in fetuses exposed to these medications in the first trimester. Another study in 2011 saw similar signals. So that signal has been replicated twice — both times in observational settings, so it’s an association and not causation, but it’s the same signal in two different studies. We were interested in looking at this from a public-health point of view. How many potential fetuses are we talking about?
GAZETTE: What is a neural-tube defect?
DESAI: The CNS [central nervous system] organs, brain and spinal cord, are formed from the neural tube in a developing fetus during the first trimester of pregnancy. Any malfunction in this process results in incomplete development of the CNS, which is potentially fatal for a newborn. It’s a very serious condition. The absolute risk of neural-tube defects is small, but the earlier studies reported doubling of this risk after first-trimester opioid exposure compared to non-exposure.
GAZETTE: You saw a 4 percent increase in use of opioids among pregnant women during the study period. Is there an epidemic of pain among pregnant women or is something else going on? What’s driving this?
DESAI: It is difficult to attribute this trend to any single factor. Obviously, there’s more recognition of pain and the need to control pain overall. Increase in the use of these agents in the general population has been well documented in various studies in the past. Our study was based on prescribing and dispensing data, so we don’t have any idea how big a factor abuse is. Our data represent filled prescriptions of opioids, so we are viewing this use as medicinal in nature.
GAZETTE: The study shows regional differences. Can you address that?
DESAI: We did see some sizable differences across states and regions. The South had the highest and the Northeast had the lowest. That could be due to a combination of several things. Underlying prevalence of pain conditions might be different in different regions and practice patterns of the physicians themselves might be different. We do know from past research that there is a huge regional variation when it comes to prescription medication [patterns].
GAZETTE: Do you have any words of wisdom for a woman who is pregnant and considering getting a prescription for some of these compounds?
DESAI: Absolutely. There has to be a discussion around the risk-benefit profile of any medication you use. If the pain is not so severe, I think physical therapy or [another alternative] could help. We are not saying these agents should not be used at all. For instance, with cancer pain or serious joint pain, these agents do work. We know that. It would be best to at least have a discussion with your physician whenever you are thinking of getting medication for your pain.
GAZETTE: What next steps are important?
DESAI: We are in the process of looking at various safety signals among fetuses after exposure to opioid agents, so I think that is the next step. This is really important and an active area of investigation. We hope to contribute more to it.