IN THIS ISSUE……

Marijuana Use Among Young Adults at All- Time High THE OFFICIAL NEWSLETTER OF THE MINNESOTA DRE SEPTEMBER 2018

Adderall Does Not EXPERTS WARN OF EMERGING Improve School Performance in College ‘ EPIDEMIC’

Students Without With the nation still reeling from the crisis, drug-forecasting experts say a ADHD new wave of addiction is coming and the isn’t ready for it. Abuse of like methamphetamine, , and even prescription drugs like Adderall and Ritalin is surging across the country, fed by cheap, potent, and Rising Number of plentiful supplies. “No one is paying attention to this,” said John Eadie, coordinator for the National Prescriptions Emerging Threat Initiative, which provides research to the government’s High Intensity Drug Trafficking Areas program. “Everyone, correctly, is focused on CBD Not “Legal In All and should be because of the known problem there. But this other problem 50 States” is catching up with us very rapidly. “We’re now facing a very significant stimulant epidemic,” said Eadie, who spoke at

Renowned Medial the National Rx Drug Abuse and Heroin Summit in Atlanta. For every kilogram of heroin -- a commonly abused opioid -- seized over the last 5 years, Edie says, drug Marijuana Doctor Says enforcement agents seized 15 kilograms of stimulants. “We have to pay attention to Concentrates Should this one. It’s very big, and it’s growing very rapidly,” he said. Be Banned Data from government surveys on drug use show that stimulant use is climbing and in some cases NHTSA 2016 Traffic outpaces opioid use. In 2016, for example, an Data estimated 2.3 million people started using opioids to get high for the first time, while 2.6 million people started using stimulant drugs for the same Effects of a Heavy purpose. In 2016, an estimated 3.8 million people Drinking Session on said they used opioids to get high within the last Our Thoughts and month, while 4.3 million said the same about Performance May Last stimulants. Longer Than We While opioids now account for most deaths in the U.S., the number of people who are dying from stimulants is also rising. Early data from the CDC show Think that the number of overdose deaths due to psychostimulant abuse -- a drug category that includes prescription and illegal stimulants -- jumped nearly 30% last year. In TIRF: Annual Ignition 2017, 7,663 people died from a stimulant overdose, up from 5,992 in 2016. Interlock Survey The reasons for the increase are not yet well understood. But historically, drug abuse tends to happen in cycles. Continued on Page 4 SEPTEMBER 2018 Page 2 MARIJUANA USE AMONG ADDERALL DOES NOT YOUNG ADULTS IS AT AN ALL- IMPROVE SCHOOL TIME HIGH PERFORMANCE IN COLLEGE

The National Institute on Drug Abuse recently released STUDENTS WITHOUT ADHD the results of its latest study, which examined trends on The attention deficit hyperactivity disorder (ADHD) substance use among non-college and college young drug Adderall does not improve reading comprehension adults. or fluency in college students without the disorder, and For their evaluation, the researchers surveyed people, may impair memory, a new study suggests. aged 19 to 22, from across the United States. Many college students believe ADHD drugs will After analyzing the results, they found more than 13 improve their study skills, Science Daily reports. The percent of young adults not in college reported using new study by researchers at the University of Rhode marijuana daily or near daily, which is the highest level Island and Brown University looked at the impact of so- ever among the group. As a result, they said daily called “study drugs” on college students who do not have marijuana use is now three times as high among non- ADHD. college young adults as among college students. The study, Vaping marijuana was also higher among non-college published in the young adults than among college students. Nearly 8 Journal Pharmacy , percent of non-college adults vaped, compared to 5.2 found the standard percent of college students. 30-milligram dose The largest difference between daily rates for college of Adderall did students and non-college adults was in the cigarette improve attention category. About 14 percent of non-college peers and focus, but did not translate into better performance smoked daily, while just 2 percent of college students on tests that measured short-term memory, reading smoked every day. Past month use of vaping comprehension and fluency. was also higher, with about 8 percent of non-college “If your brain is functioning normally in those regions, adults vaping nicotine, compared to 6 percent of the medication is unlikely to have a positive effect on college students. cognition and my actually impair cognition. In other While misuse of Vicodin in both college and non- words, you need to have a deficit to benefit from the college peers dropped about 8 percent within the last medicine,” lead researcher Lisa Weyandt said eight years, synthetic drug use over the last year was higher in non-college peers than in college students. Source: Partnership for Drug Free Kids

Source: The Atlanta Journal-Constitution RISING NUMBER OF BENZODIAZEPINE PRESCRIPTIONS

Doctors are prescribing large amounts of such as Xanax and Ativan, which can cause deadly complications, an expert tells NBC News. Dr. Anna Lembke, Chief of Addiction Medicine at Stanford University Medical Center, said complications from benzodiazepines, such as dependency and addiction, are fueling a hidden epidemic. The drugs are primarily used to treat and sleeplessness. “Medical students, residents and even doctors in practice don’t recognize the addictive potential of benzodiazepines,” Dr. Lembke said. “There’s been all this awareness on opioids but very little focus on benzodiazepines and yet people are dying from them.” Earlier this year, Dr. Lembke reported in the New England Journal of Medicine that there were 8,791 overdose deaths involving benzodiazepines in 2015, up from 1999 when there were 1,135 such overdose deaths. One study found that between 1996 and 2013, the number of adults filling a benzodiazepine prescription increased by 67 percent, reaching 13.5 million in 2013. Source: Partnership for Drug Free Kids

SEPTEMBER 2018 Page 3

NO, CBD IS NOT 'LEGAL IN ALL 50 STATES'

An Indiana man was overwhelmed with emotion this week when a county court dismissed his case. Mamadou Ndiaye was facing jail time and a $1,000 fine for marijuana possession. But Ndiaye possessed only CBD oil – a substance that was legalized by the state legislature last month. Thanks to the new CBD law, the prosecutor and judge both decided to dismiss the case. "This is the best day of my life," he told WTHR, which has been reporting on Ndiaye’s case and the confusion surrounding CBD laws in Indiana. CBD, short for cannabidiol, is a compound found in that has gained prominence in recent years for its therapeutic properties. Cannabis advocates have hailed the cannabinoid for its promise in combating seizures, anxiety and myriad other ailments. CBD is "the new ‘it’ drug," according to The Washington Post. It’s a "rapidly rising star for its capacity to deliver mental and physical benefits," according to Quartz. But contrary to what these articles suggest, CBD products are not "legal in all 50 US states." If that were the case, why would Ndiaye be charged with a crime? Why would the Indiana police raid retailers selling the stuff? And why would the Indiana legislature take it upon itself to legalize CBD? Many in the cannabis industry claim that as long as the CBD product contains less than 0.3% THC, it is classified as hemp under federal law and is therefore legal to possess and distribute. (WTHR commissioned a lab test for Ndiaye’s CBD oil — it had 0.00% THC.) The 2014 Farm Bill is often cited as evidence that CBD derived from industrial hemp is now legal. But the legislation legalized only a very narrow set of hemp cultivation activities: It is legal to grow hemp under a state pilot program or for academic research. It is also legal to cultivate under state law "in which such institution of higher education or state department of agriculture is located and such research occurs." There are certainly CBD producers who source their hemp from cultivators that operate under the Farm Bill. But given how widespread these products are, it’s unlikely that all of them were sourced from research hemp. And state laws on CBD and hemp vary widely. Colorado, which legalized adult-use marijuana in 2012, has a robust industrial hemp program and is home to the first U.S.-bred certified hemp seed. But in Massachusetts, where you can now grow marijuana at home, it’s still a crime to grow hemp without a state license, reported The Boston Globe. Republican Senator Mitch McConnell announced last month that he would introduce a bill to legalize hemp on the federal level. Meanwhile, the Drug Enforcement Administration maintains that CBD is definitely still illegal. Last November, a spokesperson for the agency explained to WTHR that those who violate federal drug laws still run the "risk of arrest and prosecution." Continued on Page 6

RENOWNED MEDICAL MARIJUANA DOCTOR SAYS CONCENTRATES SHOULD BE BANNED

Dr. Rav Ivker, a physician renowned for using cannabis to treat chronic pain, has said he believes marijuana concentrates should be banned. “I think they should be illegal,” Ivker said. “In fact, I hope they become illegal. The only thing they’re good for is getting really high. But they’re high-risk, and there’s really no benefit from them.” Ivker said that addiction is possible with “high-potency marijuana products, including concentrates like “shatter” and “wax”. These can contain from 80 to even 95 percent THC.”

Doctor Still Values Medicinal Cannabis Ivker, who is the author of Cannabis for Chronic Pain and treats patients at the Fully Alive Medical Center in Boulder, Colorado, still recommends medical marijuana therapies. But he cautioned that patients have to be wary of becoming addicted. “I advocate for cannabis as a medicine for treating chronic pain. That’s the title of my book, and Fully Alive is predominantly a chronic-pain practice, a holistic medical practice. The vast majority of my patients have chronic pain and are using medical marijuana to treat their problem, along with other modalities. And because I teach my patients how to use cannabis appropriately as a medicine, I don’t see the addiction problem among my patient population.” Continued on Page 6

SEPTEMBER 2018 Page 4

‘STIMULANT EPIDEMIC’

Continued from Page 1

The heroin epidemic of the 1970s was followed by the crack cocaine epidemic of the 1980s, for example. Melvin

Patterson, a spokesman for the Drug Enforcement Administration in Washington, D.C., says people who take stimulants generally crave a different kind of high than those who abuse opioids, so he says it’s likely that a stimulant epidemic would affect a different pool of users. Opioids create a sense of calm and euphoria. Stimulants, of course, produce bursts of energy and focus. But there is some overlap. People who are addicted to opioids -- which depress the central nervous system, making it tough to stay awake -- are also turning to stimulants to help them function.

“If you talk to heroin users, they totally use meth to keep them up,” says Karen Randall, DO, an emergency room doctor in Pueblo, CO, who was attending the conference. “They use heroin, but then they have to take the kids to school, they have to get up and do stuff, (so) they use methamphetamines,” she said. Randall says stimulant abuse can be harder on the body.

“The harms are probably greater because it affects the cardiovascular system. Cocaine and cause a great deal of hypertension and end-organ damage like heart disease, lung disease, brain disease, and stroke. I think actually amphetamines are going to be worse,” she says. In some ways, addiction to stimulants is more challenging to treat than opioid addiction. The medication Narcan can reverse an . There is no rescue drug for people who overdose on stimulants. Medications like buprenorphine and methadone curb drug craving for people addicted to opioids. There are currently no similar medications to help curb the abuse of stimulants. The National Institute on Drug Abuse is working to develop medications for stimulant abuse, says Ed Craft, DrPH, a public health analyst for the and Mental Health Services Administration in Washington, D.C. Craft says they’ve already started to see demand for meth addiction treatment services rise in some parts of the country, which have been inundated with cheap, potent supplies of methamphetamine from Mexico. “The need for slots for treatment has approximately doubled in some places,” he says.

In 2005, Congress made it tougher to get the ingredient pseudoephedrine in the United States, which is sold over the counter as a cold medicine.

The crackdown helped dry up domestic supplies of meth, but production has moved to Mexico, where the drug is made with a potent chemical that’s normally used to clean swimming pools called phenyl-2-propanone, or P2P.

“As the result of using this product, meth is a lot purer now and a lot cheaper and in plentiful supply,” Craft says. “Because it’s purer and cheaper, more people are using it, and more people are using more.”

This powerful, pure meth can bring on psychotic reactions, and in some cases, he says, people may need ongoing residential treatment after a psychotic breakdown.

Cocaine supplies are also up because of record crop production in Colombia, where the government just made a deal with farmers not to destroy coca plants and offered, instead, to pay them if they would switch to other crops. But so far, the plan has backfired as more farmers began growing coca to qualify for the cash. As a result, according to the DEA, cocaine availability and use in 2016 were at their highest levels in a decade.

Ninety-two percent of all the cocaine seized in the U.S. in 2016 came from Colombia, according to the DEA. In addition to illegal drugs, legal supplies of stimulants have never been greater. Prescriptions for stimulant medications like Ritalin and Adderall are up for all age groups, according to data from prescription drug monitoring programs. Both are typically prescribed to treat attention deficit disorders.

In Oregon, for example, the rate of stimulant prescriptions written for every 1,000 adults ages 30 to 44 increased from 159 in 2012 to 238 in 2016, about a 50% increase. The largest percent increase, puzzlingly, was in prescriptions written for people ages 65 to 74. Eadie says he doesn’t know why prescriptions are up, but he urged people in the audience to start digging into that question. “It’s the leading edge. It’s the place we’ve got to look if we’re going to start interdicting these things as early as possible,” he says.

Source: WebMD

SEPTEMBER 2018 Page 5

NHTSA 2016 TRAFFIC DATA

• The fatality rate per 100 million vehicle miles traveled (VMT) was 1.18 for the U.S. in 2016, ranging from 1.86 to 0.63 among States. Minnesota’s was 0.66.

• Thirty-nine States increased in traffic fatalities from 2015 to 2016. Minnesota decreased by 5%.

• Since 1975, the first year the Fatality Analysis Reporting System began collecting data, the rate of fatalities per 100 million VMT has decreased by 65% (3.35 to 1.18). Minnesota decreased 78% (2.94 to 0.66)

• From 2007 to 2016, South Dakota had the largest increase in the percentage of -impaired-driving fatalities at 30%, while Mississippi had the greatest decrease at 47%. Minnesota decreased by 29% during this time.

EFFECTS OF A HEAVY DRINKING SESSION ON OUR THOUGHTS

AND PERFORMANCE MAY LAST LONGER THAN WE THINK

The research, published in the Journal Addiction from psychologists at the University of Bath, highlight that impairments in cognition seen when individuals are drunk are still present the day after, when there little to no alcohol left in the bloodstream. Across the board, they highlight how hungover individuals have poorer attention, memory, and psychomotor skills such as coordination and speed when compared to when sober. The researchers suggest their findings have important implications when it comes to activities performed when hungover, including driving.

For example, while hungover, individuals might typically wait until they believe there is no alcohol in the system before driving. These new results suggest that we could still be impaired in terms of the cognitive processes required, even after alcohol has left the bloodstream. In addition, the researchers warn that although many workplaces have clear policies in place regarding at work, few cover the next day effects of alcohol.

For certain jobs, they suggest, employees should be aware of the real effects that hangovers can have, and employers might do well to consider revising guidelines on safety grounds.

Hangover is the most commonly reported negative consequence of alcohol use, and is already estimated to cost the

UK economy £1.9 billion a year due to absenteeism. Despite this, up until this point little has been done to examine the effects of being hungover 'on the job'.

Leader author Craig Gunn of the Department of at the University of Bath explained: "In our review of

19 studies we found that hangover impaired psychomotor speed, short and long term memory and sustained attention. Impaired performance in these abilities reflects poorer concentration and focus, decreased memory and reduced reaction times the day after an evening of heavy drinking. Our review also indicated limited and inconsistent research on alcohol hangover and the need for future studies in the field."

Senior author Dr Sally Adams added: "Our findings demonstrate that hangover can have serious consequences for the performance of everyday activities such as driving and workplace skills such as concentration and memory.

"These findings also highlight that there is a need for further research in this field where alcohol hangover has implications at the individual level in terms of health and wellbeing, but also more widely at the national level for safety and the economy."

The researchers are now developing this work to further examine the true health and economic costs of hangover and associated risks with the next day effects of heavy drinking. The meta-analysis involved in this study involved a review of 770 articles relating to the topic. Source: www.Sciencedaily.com SEPTEMBER 2018 Page 6

CONCENTRATES SHOULD BE ANNUAL IGNITION

BANNED INTERLOCK SURVEY Continued from Page 3 Epidemiological data regarding alcohol-impaired

Yes, Cannabis Can Be Addictive driving suggest that progress in addressing the According to research from the National Institute on problem may be stagnating. While the proportion of Drug Abuse, 9 percent of cannabis users become alcohol-impaired driving crashes out of all crashes addicted to the drug. For those that begin using as an may have been at an all-time low in 2016, there hav e adolescent, the rate climbs to 17 percent. been two consecutive increases in the absolute numb er “Marijuana, like any substance or behavior that affects of alcohol-related fatalities on the roads since 2014. the reward system of the brain, has the potential for In this context of waning progress, alcohol ignitio n dependence and possible addiction — and that includes interlock programs are especially pertinent. Their food, sex, and even television. THC releases dopamine value as an impaired driving countermeasure is clearly in the brain, and dopamine is the neurotransmitter that evident in light of the strong body of evidence causes us to have feelings of pleasure, just like food, sex showing that they not only reduce recidivism but th at and TV do,” Ivker explained. they can also lead to a reduction in alcohol-relate d He also said that many people erroneously believe that fatalities when the use of the device is embedded in cannabis is not addictive, an idea that “goes back to strong legislation. But for an effective measure to be maybe a decade or two ago, when the highest potency efficacious, market penetration is crucial. As such, the marijuana flower probably contained 5 percent or maybe purpose of this annual survey is to monitor 10 percent THC,” Ivker said. installations and installation rates and to report these “But today — and we’re talking about just the marijuana findings to the benefit of all stakeholders involved. flower — the highest sativa strains can contain 25 to 30 percent THC. That’s what most people are smoking. Source: Traffic Injury Research Foundation (TIRF) And what they’re dabbing can be two or three times more potent than that.” CBD Young People Most at Risk Continued from Page 3 Ivker noted that cannabis concentrates are popular with young people, the group most at risk of developing an But he also said that the DEA is not going after addiction to cannabis. Other dangers exist, as well. individuals who have benefited from CBD oil. “And even more concerning than the addiction problem "It would not be an appropriate use of federal is the fact that our brains are still developing until we’re resources to go after a mother because her child has in our mid-to-late twenties,” he said. “The THC affects epileptic seizures and has found something that can brain function and can create a higher risk of help and has helped. Are they breaking the law? Yes, schizophrenia, and that’s really awful. We’re definitely they are. Are we going to break her door down? seeing an increase in the number of young people Absolutely not. And I don't think she'll be charged by developing schizophrenia from the daily use of cannabis. any U.S. Attorney," DEA spokesperson Rusty Payne I think that’s the greatest health risk of all, and one told the Indiana news station. common denominator is that people who are at the Then, there’s HIA v. DEA – a lawsuit by a hemp highest risk for developing schizophrenia began using trade association that challenges the agency’s daily before the age of eighteen.” classification of CBD as a Schedule I substance. Ivker said that different forms of marijuana, including Federal judges at the Ninth Circuit Court of Appeals topicals and CBD, are a better alternative for many heard oral arguments in the case earlier this year. patients. Clearly, attorneys representing hemp businesses have “I strongly advise my younger patients to stay away a different interpretation of federal law than the DEA. from concentrates. A lot of them say they have friends So at the end of the day, CBD is not legal in all 50 who are dabbing on a daily basis. But when I warn them states — even though it is widely available. At best, about the dangers, they often tell me that they’re going the law is murky and open to differing interpretations. to let their friends know.” Source: High Times Source: Forbes