02/27/15

Surprised by My Utmost

Copyright : Kasal | 123RF.com

Copyright : Kasal | 123RF.com

Joe was an enthusiastic kind of guy. When he found something he liked, he wanted his friends to like it or try it. He’s the guy who convinced me to try rock climbing (Don’t Ever Give Up). So when he started talking about how great a devotional My Utmost for His Highest was, I took his endorsement with a grain of salt … at first. When other people who tried it started saying how much they liked it, I tried it. Oswald Chambers has been a regular part of my devotional life since then.

I still have my original copy. The binding split years ago, so I taped it with blue electric tape. It is full of notes, underlined and starred passages and a few coffee-stains. Inside is a crisp $2 bill from the Bank of Jamaica—a souvenir from a short-term missions trip to Jamaica—that I used for a bookmark. These days I’ve gone digital, with “OC” coming up daily when I open my Logos Bible software program as I drink my morning coffee. I’ve been posting selections from three different devotionals on my facebook page for a number of years now, but My Utmost always seems to be the one most quoted.

There is a short comment in my hardbound copy for the January 18th devotion, “began.” On that day I made a note summarizing what stood out to me, “be devoted to the Lord, not to service.” I had underlined the following paragraph:

Beware of anything that competes with loyalty to Jesus Christ. The greatest competitor of devotion to Jesus is service for Him. It is easier to serve than to be drunk to the dregs. The one aim of the call of God is the satisfaction of God, not a call to do something for Him. We are not sent to battle for God, but to be used by God in His battlings. Are we being more devoted to service than to Jesus Christ?

I can’t say I have always been more devoted to Christ than to service, but at least once each year Oswald asks me if I am. Actually, he does this repeatedly throughout the year. March 29th is one of those times. My page note said: “Be ready for the coming of our Lord more than to do service.”  Within the devotional for that day, Chambers had said: “It is not service that matters, but intense spiritual reality, expecting Jesus Christ at every turn.”

August 30th didn’t have a page note, but I had starred and underlined this passage:

When once you are rightly related to God by salvation and sanctification, remember that wherever you are, you are put there by God; and by the reaction of your life on the circumstances around you, you will fulfill God’s purpose, as long as you keep in the light as God is in the light.

There’s more, but I’ll stop with the quotes here. Get a personal copy and see if what Joe told me so many years ago is true for you: “It’s as if day after day, Chambers is hitting me right between the eyes with something I needed to hear.”

Oswald Chambers was born in Aberdeen Scotland on July 24th, 1874 and he died on November 15th, 1917 at the age of 43. While at the University of Edinburgh, he felt called to the ministry and went to Dunoon College, a small theological training school near Glasgow. He traveled for a couple of years in 1906 and 1907, teaching for a semester in Cincinnati and working in Japan with Charles Cowan, a co-founder of the Oriental Missionary Society. While in America he met Gertrude Hobbs, who he married in May of 1910. “Biddy,” as Chambers called his wife, could take shorthand at 250 words per minute. It was this skill that eventually contributed to her transcribing and typing his sermons and lessons into written form after his death.

In 1911, Chambers founded the Bible Training College in London, where he taught until 1915, one year after the outbreak of World War I. He suspended the operation of the school and went to Zeitoun Egypt, where he was a YMCA chaplain to Australian and New Zealand troops. But the relatively short time at his school had a big impact. “Between 1911 and 1915, 106 resident students attended the Bible Training College, and by July 1915, forty were serving as missionaries.”

In Egypt, he decided to stop the usual concerts and movies provided by the YMCA for the troops as a social alternative to the brothels of Cairo. He gave Bible classes instead. Skeptics predicted an “exodus” of soldiers from the facilities, but his wooden-framed “hut” became packed with soldiers listening to messages like “What is the Good of Prayer?” When confronted by a soldier who said he couldn’t stand religious people, Chambers replied, “Neither can I.”

He was stricken with appendicitis on October 17th, 1917, but resisted going to a hospital. He was reluctant to take a bed that was needed for the troops being massed for a long-expected battle. His delayed treatment led to needing an emergency appendectomy on October 29th. He died on November 15th from a hemorrhage in his lungs. He was buried in Cairo with full military honors.

For the remainder of her life, Biddy Chambers transcribed and published books and articles from the notes she took during their time at the Bible College and while with the YMCA in Zeitoun. My Utmost for His Highest was first published in 1927. In the foreword, she wrote:

It is because it is felt that the author is one to whose teaching men will return, that this book has been prepared, and it is sent out with the prayer that day by day the messages may continue to bring the quickening life and inspiration of the Holy Spirit.

For me, and many others her prayer was answered.

Parallel to the discipling I received from Oswald Chambers over the years has been my counseling with people struggling with drug and alcohol problems. To my surprise, when I began doing research for my dissertation on the spiritual and religious distinction in Alcoholics Anonymous and the Twelve Steps, I discovered that early A.A. used My Utmost for His Highest. According to Dick B., a Christian and A.A. historian, My Utmost was used by early A.A. members—a custom they borrowed from the Oxford Group. Actually, I guess I shouldn’t have been that surprised. This also was an answer to Biddy’s prayer.

02/25/15

Deep Brain Jolts

© Brain Energy Pulse by idesign | stockfresh.com

© Brain Energy Pulse by idesign | stockfresh.com

Michael J. Fox is probably the most well known person with Parkinson’s disease. Viewing the progression of his Parkinson’s between 1991 and an interview he did on Oprah in 2010 gives you an indication of how debilitating it can become. There is a treatment called Deep Brain Stimulation (DBS) that effectively silences the tremors. The dramatic therapeutic difference can be seen in this YouTube video of a New Zealand man named Andrew Johnson who has Early Onset Parkinson’s. The difference is dramatic and it is easy to see why he would agree to the procedure. What’s not to like about it and why would Michael and others put off trying it? It involves surgery that implants electrodes into your brain.

As described by the NIMH, DBS surgery begins with shaving your head and attaching it with screws to a sturdy frame that prevents the head from moving during surgery. The patient is awake during the procedure to help the surgeon with feedback. Patients feel no pain, however, because their head is numbed with a local anesthetic. MRIs are taken of the brain to guide the surgeon during the operation.

Once the above prep work is completed, two holes are drilled into the head. The surgeon then threads a slender tube down into the brain in order to place electrodes on each side of a specific part of the brain. After the electrodes are implanted and the patient provides feedback about the placement, the patient is then put under general anesthesia. The electrodes are now attached to wires that run inside the person’s body down to the chest, where a pair of battery-operated generators are implanted.

Electrical impulses are then continuously delivered over the wires to the electrodes in the brain. After the device is fine tuned, it reduces tremor and uncontrollable movements, stiffness and walking problems related to Parkinson’s. You can see how this all works afterwards in the Andrew Johnson video. At this point, DBS has been used in more than 100,000 people worldwide.

Helen Shen wrote in Nature that the biological mechanism underlying DBS is still unknown. Michael Okun, a neuroscientist, said there has been a lot of guesswork done with DBS over the past twenty years. “It would be premature for anyone to claim they know how the therapy works.” There are some hypotheses, though. The current theory is that DBS somehow disrupts or represses pathological signals that reverberate through multiple brain regions, thus corrupting their communications.

This fits with the emerging view that Parkinson’s disease, depression and other neuropsychiatric conditions are best understood as neural network dysfunctions. At this time DBS is approved by the FDA to treat the following: essential tremor (1997), Parkinson’s (2002), dystonia [a neurological movement disorder] (2003) and OCD (2009). There is research being done to assess it applicability to addiction and depression.

Helen Shen described a new device from Medtronic that is now being used in DBS treatment. The Medtronic neurostimulator not only will send electricity into the brain, it will also read neural signals generated by the brain and send them out.

Until now, such data have been accessible only when a patient’s brain is exposed briefly during surgery. But being able to make long-term neural recordings from human patients may become increasingly important — especially because researchers are experimenting with using DBS as a treatment for many other neurological conditions.

But the neural networks in these other neurological disorders are even less understood than those involved in Parkinson’s. Helen Mayberg, a neurologist at Emory University said devices like the Medtronic neurostimulator could change that, but “Every disease will be different and one size won’t fit all. . . .  [However] the new technology is going to enable progress exponentially.” Helen Bronte-Stewart, a neuroscientist, said this was an exciting time. “This is the first time we’re really getting a window into the brain.”

Others, such as medical ethicist Joseph Fins, urged caution. He also indicated that while the sensiorimotor network involved in Parkinson’s disease is mapped out in great detail, the other disorders have much less guidance available. “There has got to be a biological rationale for what you’re intending to do.” Others argue that controlled testing of DBS in humans doesn’t need to wait for complete or near complete understanding of the relevant networks.  Benjamin Greenberg, a psychiatrist at Brown University said that as a clinician, that wasn’t an important question. “The real questions are: do these treatments help people? Are they safe?”

The NIMH indicated, “DBS carries risks associated with any type of brain surgery.” The side effects or complications could include: stroke or bleeding in the brain; infection; disorientation or confusion; unwanted mood changes; movement disorders (isn’t DBS supposed to treat these?); lightheadedness; trouble sleeping. And DBS does not halt the progressive neurodegeneration of Parkinson’s. In the long run, patients will succumb to symptoms not effectively treated by DBS, like cognitive deterioration.

An article by Jeanene Swanson for The Fix referred to DBS surgery as a “relatively simple neurological procedure” (?) that could be used to treat a variety of disorders, including addiction, severe depression cluster headaches and obesity (None of these are approved DBS treatments at this time). DBS treatment for addiction was accidently “discovered” in 2006 by Jens Kuhn of the University of Cologne when Kuhn tried DBS as a treatment for panic disorder. “Recent valid animal studies show significant induced improvement in cocaine, morphine, and alcohol addiction behavior following DBS of the nucleus accumbens.”

Wayne Hall indicated that the interest in using DBS for treating addiction isn’t great. He suspected this was because it is an expensive, high technology intervention for a small minority of patients. He further noted that interest has declined for using DBS for depression because of poor trial results. However, that could be resurrected if more promising sites for stimulation were identified.

I would predict that if DBS is used for addiction in the future it will only be used in a minority of patients and will remain a niche treatment for addiction rather than becoming a mainstay form of treatment as it looks like it’s becoming for Parkinson’s disease and other movement disorders.

Dr. Nadar Pouratian of UCLA thinks it can be a promising treatment for addiction, but the earliest it could be available would be five years from now. “I think it’s a promising therapy for a spectrum of diseases, including addiction, but we need to be a little bit more methodical or careful—every time a trial does not work, the negative repercussions [do] far greater harm to the field.”

Could that be because DBS for addiction and depression is therapeutic overkill? Could it be because it’s dangerous when applied for addiction and depression? When the current state of knowledge doesn’t know how DBS works, and when the complexity of the neural networks for addiction and depression aren’t clearly understood, treating them with DBS seems like taking a huge risk.

02/23/15

It’s Not a Party Drug

© : Olaf Herschbach 123RF.com

© : Olaf Herschbach 123RF.com

On January 23, 2006, after spending the weekend filling out applications for college and talking to his girlfriend about getting married after finishing college, seventeen-year old Brett Chidester took his life. His mother told David Schaefer on “All Things Considered” that the previous August she had found out Brett was using Salvia and confronted him, asking him to stop. He agreed, and she flushed his bag of Salvia down the toilet. After his death, she discovered that wasn’t the case. She found receipts for Internet purchases of Salvia and an essay he had written about his salvia experience.

In the essay Brett wrote that tripping on salvia allowed him to give up his senses and wander into “inter-dimensional time and space.” He said that he had discovered the secrets to the universe; and that there were other worlds. He also said that earthly human existence was pointless. His mother said that the essay echoed what Brett wrote in his suicide note. She said in an ABC Nightline interview: “I think he had smoked salvia to such an extent that something happened in his brain.”

In 1962 Gordon Wasson and Albert Hofmann (the first person to synthesize and ingest LSD) collected samples of a hallucinogenic Salvia plant and sent it to Carl Epling, an American botanist, for identification as a unique species. They called it, Salvia divinorum (meaning sage of the diviners). Wasson suggested that S. dininorum could be the unknown Aztec sacramental plant called “pipiltzintzinli,” but that is not a widely accepted hypothesis.

In 1994, Daniel Seibert began to publish his investigations into the effects of Salvinorin A (the psychoactive ingredient in Salvia divinorum). This began what is now a worldwide phenomenon, with plants leaves and extracts sold online and in head shops or tobacco shops. While it is a controlled substance in some U.S. states, the DEA said the federal government has yet to classify S. divinorum under the Controlled Substances Act.  Nor does it have any currently approved medical uses in the US. Seibert gave the following warning about SalvA in his 1994 article,

Salvinorin A (the major active principal of the plant Salvia divinorum) is an extremely powerful consciousness altering compound. In fact it is the most potent naturally occurring hallucinogen thus far isolated. But before would-be experimenters get too worked-up about it, it should be made clear that the effects are often extremely unnerving and there is a very real potential for physical danger with its use. . . . The majority of people who have had a full blown experience with salvinorin A are reluctant to ever do it again. Anyone choosing to experiment with this compound should always have an alert, clear-thinking sitter present to prevent them from injuring themselves or others.

© Photo by Carl P. McCall |wikipedia.org

salvia divinorum © Photo by Carl P. McCall |wikipedia.org

According to Wasson, S. divinorum was used by the Mazatec Indians of Oaxaca, Mexico, in their healing and divination rites. Many Mazatec families possess a private supply of the plants. But the plants were not near homes or trails where they could be easily seen by others. The Mazatecs choose a remote ravine and are reluctant to reveal their growing spots.

There isn’t agreement on whether salvia leads to a depressed state or not. Daniel Seibert, an expert on the pharmacological effects of Salvia, didn’t think anyone would commit suicide as a result of a salvia experience. “That’s just so inconceivable to me.” He said that when used responsibly, it is beneficial—helpful for deepening awareness and introspection. He’s used it himself. “Sometimes I’ve taken salvia where I’ve had some difficult life situation, relationship problem, or something like that where I was uncertain about what I should do.”

Seibert isn’t the only person who sees the potential with salvia. A 2010 study by Baggott et al. concluded that salvia effects were brief, lasting between 12 and 14 minutes. Persistent adverse effects were said to be uncommon. In addition to its strong hallucinogenic effect, it also produced a subjective sense of well-being. Participants in the study reported increased insight (47%); improved mood (44.8%); calmness (42.2%); and an increased connection to the universe (39.8%). But they also had weird thoughts (36.4%); things seemed unreal (32.4%); racing thoughts (23.2%); felt like someone or something else (14%); and anxiety (9.4%). The reported abuse potential was found to be low.

A 2014 study by Kivell et al. noted that salvia has both pro- and anti-depressant effects. The short half-life makes it undesirable for clinical use. But there is hope that ongoing research into analogs for Salvinorin A (the psychoactive ingredient in Salvia) will lead to the development of anti-depression therapeutics. A 2012 study by Harden et al. in rats suggested that SalvA “reversed anhedonia” and was an effective antidepressant agent. A 2015 study reviews the pre-clinical evidence suggesting potential anti-addictive effects of SalvA and its analogs.

Psychologist Peter Addy completed his dissertation on the effects S. divinorum in 2010. His review of the literature suggested that it was extremely potent and short acting, with few reported negative consequences. It also seemed that controlled, low dose SalvA had possible antidepressant effects. He added that SalvA inebriation appeared to be unique from other psychoactive substances. Anecdotal reports I’ve read indicate it doesn’t have the same euphoric feeling as other psychoactive substances. There is also a shorter article, “Acute and Post-Acute Behavioral and Psychological Effects of Salvinorin A in Humans” from what seems to be the same reach data used in his dissertation.

Salvia has garnered some media attention (i.e., “Why is Salvia so Uniquely Terrifying?” or “Salvia: The Least Fun Drug in the World”) that raises concerns with its recreational use. Controlled, low dose SalvA may have some potential for treating acute depression. Its unique psychoactive effects appear to make it a poor choice for recreational use. Even researchers like Daniel Seibert and Peter Abby have expressed concerns about its casual, recreational use. Abby said that very few people would consider its use to be fun in any way. “It’s not a party drug.”

02/20/15

Did God Make You?

© : Cosmin-Constantin Sava 123RF.com

© : Cosmin-Constantin Sava 123RF.com

At the beginning of December in 2014, a BioLogos-funded study of the beliefs in human origins was publically released.  Jonathan Hill, a sociology professor at Calvin College, conducted the study: The National Study of Religion and Human Origins (NSRHO). The survey had two primary purposes. The first was to “disaggregate” (separate into component parts) the typical survey questions used in the past to assess beliefs on human origins. The second purpose was to look at the influence of social context on these beliefs. The result may surprise you.

Gallup polls on evolution have been asking Americans which of three statements come closest to their beliefs on the origin and development of human beings for a number of years. Those positions and the percentages of Americans identified within the 2014 Gallup poll are as follows. First, human beings have developed over millions of years from less advanced forms of life, but God guided this process (31%). Second, human beings have developed over millions of years from less advanced forms of life, but God had no part in this process (19%). And third, God created human beings pretty much in their present form at one time within the last 10,000 years or so (42%).

As Jonathan Hill pointed out, if we categorize these results into “pro” and “anti” evolution camps, “it appears that nearly half the nation affirms evolution and nearly half denies it.” These statistics have then been used by a variety of sources for commentaries on evolution and creationism. But if such a large percentage of Americans continue to deny evolution, “then why do Americans score near the top on international comparisons of science literacy?”

He suggested that a better picture of beliefs about evolution was needed. So the NSRHO included separate questions on human evolution, God’s involvement, the way God created, the existence of a historical Adam and Eve, belief in literal 24-hour days of creation, and the geological timeframe for the emergence or creation of humans. Respondents could also say they were not sure about any particular question. And after each question they were asked to rate their level of certainty.

When a position affirming the main points of young earth creationism is assessed, namely that: a) that humans did not evolve from other species, b) that God was involved in the creation of humans, c) that God created directly and miraculously, d) that Adam and Eve were historical figures, e) that the days of creation were literal twenty-four hour day, and f) that humans came into existence within the last 10,000 years, only 8% of respondents agreed with all the main points of young earth creationism. Note how this contrasts with the Gallup “young earth” creationist category claiming 42% of Americans held that belief.

Taking a broad sense of theistic evolution, namely that respondents believed in human evolution and that God (or an intelligent force) was somehow involved in the creation of humans, only 16% of the population could be placed in that category. Additionally, only half of that group (8%) was very or absolutely certain of both of these beliefs. When a stricter definition is used, only 5% of the population claimed that a) humans evolved, b) God was involved, c) the days of creation were not literal, and d) humans emerged more than 10,000 years ago.  If certainty on all these points was required, the percentage dropped to only 2% of the population. The Gallup poll category suggested 31% of Americans were “theistic evolutionists.”

Atheistic evolutionists, respondents who believed that humans evolved and God was not involved in the process, were around 9% of the population. Like theistic evolutionists, this group was about half the size of the comparable category from the Gallup poll. If a measure of certainty is included, only 6% of the population said they were very or absolutely certain that humans evolved and God was not involved in the process. The way that the NSRHO defined “atheistic evolutionist,” meant that someone could believe in God or an Intelligent force in the universe, but still hold to the two core beliefs of atheistic evolution.

By separating the beliefs in this way, much smaller proportions of the population were found to hold to the dominant positions on human origins. Many others were uncertain about what they believed or held uncommon beliefs (i.e., humans did not evolve from earlier species, and God had nothing to do with the emergence of humans).

Using the most generous definitions, the NSRHO finds that 37 percent of the population can be considered creationists, 16 percent can be considered theistic evolutionists, and nine percent can be considered atheistic evolutionists. This leaves 39 percent of the population as unsure or holding uncommon views . . . . If we adopt more restrictive definitions, these numbers begin to shrink further.

These results gave a more nuanced sense to the typical polls on American beliefs in evolution. In “The Recipe for Creationism,” a BioLogos article introducing the NSRHO study, Jonathan Hill described some of the factors that seemed be important for influencing a convinced creationist. These factors were: a) belonging to an evangelical Protestant denomination, b) believing that the Bible contained no errors, c) praying frequently and d) saying that faith was very or extremely important in day-to-day life. Some factors of social context were also important for convinced creationists. They were: a) belonging to a congregation that rejected human evolution and b) anticipating that changing beliefs about human origins could cause tension with religious leaders and other church members.

You can review the NSRHO for more information on the influence of social context on the various positions. But the most important takeaway, according to Hill, is that individual beliefs practices and identities are important, “but they only become a reliable pathway to creationism or atheistic evolutionism when paired with certain contexts or certain other social identities.” They are not mashed together from the free-floating ideas put together after considering all the alternatives. Rather, “they are found in certain social locations, and they become most plausible when shared with others (especially for creationists).”

I had an opportunity about twenty years ago to see a play put on by a local theater company in Dayton Tennessee, where the Scopes Monkey Trail was held. They performed it in the very same courtroom where the original trial was held. They also used several artifacts from the original trial as props for the play. The dialogue in the script for the play was overwhelmingly taken from the transcript from the trial. It was a special experience, feeling a bit like being able to be present at an important time in history.

It saddens me to see the perpetuation of fanaticism on both extremes of the evolution-creation debate. Particularly when Christians who are trying to honor their faith get caught up in spewing vitriol about positions that disagree with theirs. So I’d like to end this look at the BioLogos survey with a quotation of Clarence Darrow. Darrow was the defense attorney for Scopes at the trial.

Ignorance and fanaticism is ever busy and needs feeding. Always it is feeding and gloating for more. Today it is the public school teachers, tomorrow the private. The next day the preachers and the lectures, the magazines, the books, the newspapers. After a while, your honor, it is the setting of man against man and creed against creed until with flying banners and beating drums we are marching backward to the glorious ages of the sixteenth century when bigots lighted fagots to burn the men who dared to bring any intelligence and enlightenment and culture to the human mind. (Clarence Darrow, July 13, 1925)

02/18/15

Hellish Withdrawal 101

© : Todd Arena 123RF.com

© : Todd Arena 123RF.com

Melissa Bond described herself as never having any physiological or psychological dependencies on anything “… besides perhaps rock climbing, yoga and writing large volumes of poetry.”  She developed pregnancy-related insomnia and went to an MD who specialized in hormonal imbalances, where she confirmed her insomnia involved an endocrine problem. She didn’t know at the time that her doctor had a “strong proclivity for prescribing benzodiaepines.”  You can read about her experience in the article she did for Mad In America: Killer Brain Candy.

After 2 years of Ativan for pregnancy-related insomnia, and the knowledge that the drug was slowly disassembling her brain and body, Melissa Bond went through a hellish withdrawal. She writes about it on her website and in her forthcoming book “Dear Little Fish.”

Melissa followed medical advice; and was told by a doctor who she trusted and respected that he knew a man who had used benzos for nineteen years and didn’t have a problem. “This drug, he told me, is phenomenal. You’ll sleep. And when you don’t need them anymore it may or may not be slightly difficult to get off but you’ll be fine.” That wasn’t what happened.

The advice I give to the drug addicts and alcoholics applies here as well. Whenever a medical person recommends that you take a potentially addictive drug for any reason, ALWAYS ALWAYS get a second opinion from someone with knowledge about addiction. Do research on people who have used the medication being prescribed to you. Mad in America, RxISK and Psychiatric Drug Facts with Dr. Peter Breggin are good places to start. And as you will see on these sites, hellish withdrawal problems aren’t confined to just the drugs classified as “addictive.”

What follows is just some basic information on how drugs are classified as controlled substances by the U.S. government. Remember that Melissa’s experiences were with a benzodiazepine, which are considered a Schedule IV controlled substance—the next to the lowest of the schedules.

There was a time when there was no federal laws regulating the use or distribution of drugs. Cocaine was in wine, cola and toothache drops; opiates were in everything from cough suppressants to teething medication. As a direct result of the Hague Convention in 1912, which was an international attempt to regulate opium, the U.S. passed the Harrison Tax Act in 1914. But it only regulated and taxed the production, importation and distribution of opiates and coca (cocaine) products. Doctors could prescribe these “narcotics” in the course of medical treatment. However they could not be used as a way to treat addiction.

While the Controlled Substances Act (CSA) of 1970 essentially replaced the Harrison Tax Act, there have been several lasting effects from this 100 year-old legislation. It began using the term ‘narcotics’ to refer to any illegally used substance. It also initiated the social construct of the “criminal” drug addict and the black market for drugs. But there still wasn’t any federal oversight and regulation of drug development. It wasn’t until the 1962 Kefauver-Harris Amendments that the Food and Drug Administration (FDA) was created, which was to approve the safety and effectiveness of a drug being developed for human consumption.

The CSA is the federal drug policy regulating the manufacture, importation, possession, use and distribution of certain substances. It created five Schedules or classifications for drugs; with varied qualifications for a substance to be included in each of the schedules. Two federal agencies, the Drug Enforcement Administration (DEA) and the FDA typically determine which substances are added to or removed from the various schedules. There have been several amendments to the CSA since 1970, including the Psychotropic Substances Act of 1978 and The Electronic Prescriptions for Controlled Substances Act of 2010.

The placement of a drug into a specific Schedule or the reclassification of a drug from one Schedule to another is based upon a series of laws under Title 21, which governs food and drugs in the United States. Each Schedule requires that the “potential for abuse” for a substance has to be determined before in can be placed within its respective Schedule. According to the DEA,  “The abuse rate is a determinate factor in the scheduling of the drug.”

The hierarchy begins with Schedule V drugs at the lowest level and ends with Schedule I drugs at the highest level. The designated abuse potential of drugs increases as you move up the hierarchy from Schedule V to Schedule I. Schedule I drugs are defined as having no current accepted medical use and a high potential for abuse. They are the most dangerous drugs, “with potentially severe psychological or physical dependence.”  Schedule V drugs are defined as having the lowest potential for abuse and are generally antidiarrheal, antitussive [cough suppressant] and analgesic medications. See the DEA link for a description of each of the five drug Schedules.

Sometimes the Schedule within which a drug is placed is controversial, and doesn’t seem to follow what would to be a common knowledge of a drug’s abuse potential. One example of this is marijuana. While it has a significantly lower dependency liability and harm potential than heroin (See “The Most Addictive and Harmful Drugs”), it is placed within Schedule I with heroin. This means that research into its potential medicinal use is highly regulated and difficult to do. There are other times where drugs are rescheduled, as was the case with Vicodin, when it became a Schedule II controlled substance instead of a Schedule III controlled substance in October of 2014 because it had become the most widely abused prescription opioid.

The following chart places some of the more common drugs within their current Schedules. You can review a pdf of all Controlled Substances in alphabetical order if there is one you don’t see here and want to check.

Schedules

Drugs

Schedule I

Heroin, marijuana, LSD, peyote, mescaline, ecstasy, MMDA, ibogaine, Quaalude, psilocybin,

Schedule II

Cocaine, morphine, methadone, methamphetamine, hydromorphone, oxycodone, hydrocodone, fentanyl, Adderall, Ritalin, Concerta, Vicodin, codeine, Demerol, Nembutal, PCP,

Schedule III

ketamine, anabolic steroids, testosterone, Suboxone (buprenorphine),

Schedule IV

Xanax, Klonopin, Valium, Ativan, Soma, Provigil, Serax, Serenel, Talwin, Tramadol/Ultram, Halcion, Ambien, Lunesta, Sonata,

Schedule V

Robbitussin AC, Lacosamide, Pyrovalerone, Lomotil

02/16/15

Legacy of the “Joy Plant”

There is a new, allegedly less addictive painkiller in the pharmaceutical pipeline, CR845, by Cara Therapeutics. Although CR845 is being touted as “non-addictive” (here and here); or a “non-absusable alternative to narcotic opioids” by Cara Therapeutics, that remains to be seen. CR845 is anticipated to be a Schedule 5 controlled substance. This is significantly less addictive than OxyContin and other opioid pain relievers, which are mostly Schedule 2. Even a less addictive pain medication would be great. But the history of opiates is full of similar promises.

The earliest reference to opium was in 3,400 BC where the Sumerians in lower Mesopotamia referred to it as Hul Gil, the “joy plant.” They, in turn, passed the knowledge of the opium poppy to the Assyrians, who gave it to the Babylonians, who passed it on to the Egyptians. The Egyptians were famous for their poppy fields and the opium trade flourished during the eighteenth dynasty (around 1500 to 1300 BC) under the reigns of Thutmose IV, Akhenaton and King Tutankhamen.  Roman gladiators used opium to enhance their fighting … and to die as painlessly as possible if mortally wounded.

Hippocrates, the father of medicine, saw opium as a helpful narcotic for treating disease. The great physician Galen, cautioned that opium should be used sparingly in 158 AD. He said it was better to endure pain than to be bound to the drug. It wasn’t until 400 AD that opium was introduced into China by Arab traders.

A History Channel documentary reported that Alexander the Great used opium to help his soldiers march farther because they couldn’t feel the pain in their feet; and they could sleep through the night because the wounded were sleeping peacefully under the influence of opium. He introduced opium to India, where it’s cultivation flourished. One of the goals of Columbus was to bring back opium from India, as its access had been cut off when the Arabs were expelled from Spain. He didn’t get to India, but he brought back tobacco from the New World and smoking tobacco became common throughout Europe.

Portuguese traders began smoking a tincture of opium with their tobacco around 1500. They also discovered the euphoric effect was instantaneous. In 1680, the English apothecary Thomas Sydenham introduced laudanum, a compound of opium, sherry wine and herbs. Dutch traders introduced the practice of smoking opium to the Chinese around 1700. The Chinese loved the habit and it led to cultural and political ruin. By 1800, 1/3 of the country was addicted to opium.

In 1803, a German chemist named Friedrich Sertuerner synthesized morphine from opium. Sertuerner’s wife overdosed on morphine and died. He then publically warned against its dangers. But morphine was also a great step forward in medicine. It allowed doctors to do true surgery for the first time. Morphine was heralded as “God’s own medicine” for its reliability and long-lasting effects. By 1827, the E. Merck & Company of Darmstadt Germany was commercially manufacturing morphine.

A new technique for administering morphine was developed by Dr. Alexander Wood of Edinburg when he invented the syringe in 1843. Wood believed that if morphine was injected instead of swallowed, “patients would not hunger for it.” He was wrong; and several of his patients became dependent. There is a mythical story that Wood’s wife was among the earliest of these addicts, and died of a morphine overdose. But according to Richard Davenport-Hines, she outlived her husband and survived until 1894.

Needles and morphine were quickly in demand. You could order morphine, opium and syringes through the mail … from Sears and Roebucks. They became a blessing during the Civil War on the battlefield. But their use created a generation of young ex-soldiers as morphine addicts. Morphine addiction became known as “the soldier’s disease” or “the army’s disease.”  This was the first drug epidemic in the United States. Nineteenth century America became “a dope fiend’s paradise.”

Morphine even became part of medical missionary efforts in China. They were selling opium pills and morphine powders, which became known as “Jesus opium.” The Chinese Recorder and Missionary Journal, Vol. 19, published in 1888, had a letter from a concerned person in Foochow: “Missionaries who dabble in this kind of business, probably most of them innocently, should know that their supposed help to suffering humanity is in the majority of the cases an injury to the patient and a positive evil in the church.”

Dr. John Witherspoon warned his fellow doctors in a June 23, 1900 article about their indiscriminant use of morphine. The morphine habit was growing at an alarming rate; and doctors were culpable for “too often giving this seductive siren until the will-power is gone.” Pointing to the Great First Physician, he said doctors should “save our people from the clutches of this hydra-headed monster” which wrecked lives and filled jails and lunatic asylums.

Looking for a non-addictive derivative of opium that could be used as a cough suppressant, the Bayer chemist Felix Hoffman successfully synthesized diacetylmorphine—heroin. When a Bayer executive introduced the drug to the Congress of German Naturalists and Physicians, he said it was 10 times more effective as a cough suppressant than codeine; it was more effective than morphine as a pain reliever and not habit-forming. Bayer began to sell it commercially in 1898 and by 1899 was producing about 1 ton of heroin yearly. The Boston Medical and Surgical Journal said heroin had many advantages over morphine, including: “It’s not hypnotic, and there’s no danger of acquiring a habit.”

Reports of “heroinism” had already surfaced, by 1900, but it took time for the sale and endorsements of heroin to stop. In 1906, the American Medical Association approved heroin for medical use, while cautioning that a “habit” was “readily formed.” In 1913, Bayer stopped making heroin. In 1919 it became illegal for doctors to prescribe heroin to addicts. In 1924, the US banned the use and manufacture of heroin altogether.

02/13/15

Entering Into Temptation

© : Ying Feng Johansson 123rf.com

© : Ying Feng Johansson 123rf.com

Whilst it knocks at the door we are at liberty; but when any temptation comes in and parleys with the heart, reasons with the mind, entices and allures the affections, be it a long or a short time, do it thus insensibly and imperceptibly, or do the soul take notice of it, we “enter into temptation.” (John Owen)

John Owen published Temptation in 1658 to address the nature of temptation, what it means to enter into temptation, and how to prevent it.  A previous article: “Lead Us Through Temptation,” looked at the nature of temptation. Here we begin to look at what it means to enter into temptation. Owen built each of these three facets of his work around the caution given by Jesus to his disciples in the Garden of Gethsemane: “Watch and pray that you may not enter into temptation” (Matthew 26:41).

Entering into temptation is not simply being tempted, according to Owen. We cannot expect to avoid temptation. “Whilst Satan continues in his power and malice, whilst the world and lust are in being, we shall be tempted.”  However, the Lord’s Prayer pleads that we be not led into temptation. So then it is possible that we could be tempted, but not actually enter into temptation.

Then it must be something more than the ordinary, daily business of being tempted by our lusts. Perhaps it is something to do with the seduction or allurement of sin. Entering into temptation is analogous to a man falling into a pit from which he does not see how he can escape. But the Lord knows how to rescue the godly from temptation (2 Peter 2:9).

When we entertain a temptation, we enter into temptation. But entering into temptation is not the same as being conquered by it. A person may enter into temptation, yet not fall under temptation. God can make a way for the individual to escape. She can break through the snare, and be more than a conqueror—even though she entered into temptation. Remember that Christ himself entered into temptation, but was not stymied by it.

When we enter into temptation, there is usually some special action or occasion by which Satan tempts us. Something beyond his ordinary allurements and seductions. It provokes some greater tumult, a more profound corruption than normal. Our hearts become so entangled with this desire, that we debate whether or not to act on it. And therefore we are not “wholly able to eject or cast out the poison and leaven that hath been injected.”

The entanglement continues, usually to be manifested in one of two ways. First, for reasons known only to himself, God permits Satan to have some particular advantage over the person. Second, the individual’s own lusts and corruptions encounter objects and occasions that are especially provoking. The conditions and circumstances of the person’s life appear to have been almost orchestrated to manifest the opportunity for temptation.

This state of affairs is properly called the “hour of temptation.” It is the time or season in which everything comes to a head—when we have truly entered into temptation. “Every great and pressing temptation hath its hour, a season wherein it grows to a head, wherein it is most vigorous, active, operative, and prevalent.” It may take a long time to rise up. But there is a time when, from the confluence of outward and inward circumstances, it manifests itself fully and completely.

That very temptation, which at one time had little or no power and was easily resisted, now bears the person away quite like a rushing torrent. Either it has gained new strength from other circumstances, or the person has been weakened somehow. David likely had prior temptations to adultery and murder, like in the case of Nabal; but his hour of temptation had not come. So stay alert for the hour, for who is not tempted?

There will be a time when the cravings of temptation will be more urgent; their justifications more plausible; their facades more glorious; their opportunities more available; their entranceways seemingly more beautiful than ever before. Blessed is the person who is prepared for such a time for there is no escaping it. “If we stay here we are safe.”  Here is how we may know that any temptation had reached its high noon and is in its hour.

First, it solicits frequent and persistent thoughts of the evil it seeks to be manifested. At first, the soul in indignation will be offended at the thoughts. But by entertaining the thoughts, the soul grows familiar with it. Instead of being startled as before, it may say, “Is it not a little one?” Then the temptation is approaching its high noon. Lust has been enticed and entangled and is ready to conceive (James 1:15).

Second, when the temptation is known to have prevailed against others, the soul is not filled with dislike and abhorrence of them and their ways. There is no pity or prayer for the other person’s deliverance. And when a temptation has been able to bring low anyone who had previously been able to prevail against it, surely its hour grows closer. “Its prevailing with others is a means to give it its hour against us.”

Third, it will complicate the situation by insinuating itself with many considerations that are not in themselves clearly evil. So it was with the Galatians and their fall from the purity of the gospel. They sought freedom from persecution as well as union and approval with the Jews. Things that were in themselves good were pleaded for, but gave life to the temptation itself.

Fourth, when its hour approaches, a temptation is restless and urgent. “It is the time of battle, and it gives the soul no rest.” Satan sees that it is now or never. So he musters his forces—the opportunities, pleas and pretences for sin. Some ground has already been taken by previous efforts. If he can do nothing now, all is lost.

Fifth, when fears and allurements are joined together, “temptation is in its hour.”  People sometimes are carried into sin by their love of it; and continue in it out of fear for what will come of it. “But in any case, where these two meet, something allures us, something affrights us, and the reasonings that run between them are ready to entangle us, then is the hour of temptation.”

This then is what it means to “enter into temptation.” And there are two means by which we are to prevent it: Watch and Pray. The first is a general expression to be on our guard; to consider all the ways and means by which an enemy could approach us (1 Corinthians 16:13).

A universal carefulness concernment and diligence, exercising itself in and by all ways and means prescribed by God, over our hearts and ways, the baits and methods of Satan, the occasions and advantages of sin in the world, that we be not entangled, is that which in this word is pressed on us.

Of prayer, Owen said he did not need to speak of it. He felt the duty of prayer was known to all. Together with being on guard, “these two comprise the whole endeavour of faith for the soul’s preservation from temptation.”

There are many areas of temptation to which John Owen’s advice can apply. But as I read this chapter, I was struck by its uncanny applicability to individuals who struggle against addiction. Lord, may they watch and pray so that they do not enter into temptation. A digital copy of Owen’s work, Of Temptation, is available here.

02/11/15

Open Access Could ‘KO’ Publication Bias

© : Antonio Abrignani 123rf.com

© : Antonio Abrignani 123rf.com

A crisis of sorts has been brewing in academic research circles. Daniele Fanelli found that the odds of reporting a positive result were 5 times higher among published papers in Psychology and Psychiatry than in Space Science. “Space Science had the lowest percentage of positive results (70.2%) and Psychology and Psychiatry the highest (91.5%).”

Three Austrian researchers, Kühberger et al., randomly sampled 1,000 published articles from all areas of psychological research. They calculated p values, effect sizes and sample sizes for all the empirical papers and investigated the distribution of p values. They found a negative correlation between effect size and sample size. There was also “an inordinately high number of p values just passing the boundary of significance.” This pattern could not be explained by implicit or explicit power analysis. “The negative correlation between effect size and samples size, and the biased distribution of p values indicate pervasive publication bias in the entire field of psychology.” According to Kühberger et al., publication bias was present if there was a better chance of publication if there were significant results in the analysis.

Publication bias can occur at any stage of the publication process where a decision is made: in the researcher’s decision to write up a manuscript; in the decision to submit the manuscript to a journal; in the decision of journal editors to send a paper out for review; in the reviewer’s recommendations of acceptance or rejection, and in the final decision whether to accept the paper. Anticipation of publication bias may make researchers conduct studies and analyze results in ways that increase the probability of getting a significant result, and to minimize the danger of non-significant results.

Charles Seife, in his December 2011 talk for Authors@Google, said it succintly: “Most published research findings are wrong.” Seife was speaking on the topic of his book, Proofiness: The Dark Arts of Mathematical Deception.”  But Seife is not alone in this opinion, as several others have made the same claim. In 2005, John Ioannidis published “Why Most Published Research Findings Are False” in PLOS Medicine. He said that for many scientific fields, claimed research findings may often be just measures of the prevailing bias of the field. “For most study designs and settings, it is more likely for a research claim to be false than true.” Uri Simonsohn has been called “The Data Detective” for his efforts in identifying and exposing cases of wrongdoing in psychology research.

These and other “misrepresentations” received a lot of attention at the NIH, with a series of meetings to discuss the nature of the problem and the best solutions to address it. Both the NIH (NIH guidelines) and the NIMH (NIMH guidelines) published principles and guidelines for reporting research. The NIH guidelines were developed with input from journal editors from over 30 basic/preclinical journals in which NIH-funded investigators have most often published their results. Thomas Insel, the director of MIMH, noted how the guidelines aimed “to improve the rigor of experimental design, with the intention of improving the odds that results” could be replicated.

Insel thought it was easy to misunderstand the so-called “reproducibility problem”  (see “The Reproducibility Problem“). Acknowledging that science is not immune to fraudulent behavior, he said the vast majority of the time the reproducibility problem could be explained by other factors—which don’t involve intentional misrepresentation or fraud. He indicated that the new NIH guidelines were intended to address the problems with flawed experimental design. Insel guessed that misuse of statistics (think intentional fraud, as in “The Data Detective”) was only a small part of the problem. Nevertheless, flawed analysis (like p-hacking) needed more attention.

An important step towards fixing it is transparent and complete reporting of methods and data analysis, including any data collection or analysis that diverged from what was planned. One could also argue that this is a call to improve the teaching of experimental design and statistics for the next generation of researchers.

From reading several articles and critiques on this issue, my impression is that Insel may be minimizing the problem (see “How to Lie About Research”). Let’s return to Ioannidis, who said that several methodologists have pointed out that the high rates of nonreplication of research discoveries were a consequence of “claiming conclusive research findings solely on the basis of a single study assessed by formal statistical significance, typically a p-value less than 0.05.” As Charles Seife commented: “Probabilities are only meaningful when placed in the proper context.”

Steven Goodman noted that p-values were widely used as a measure of statistical evidence in medical research papers. Yet they are extraordinarily difficult to interpret. “As a result, the P value’s inferential meaning is widely and often wildly misconstrued, a fact that has been pointed out in innumerable papers and books appearing since at least the, 1940s.” Goodman then reviewed twelve common misconceptions with p-values. He also pointed out the possible consequences of these misunderstandings or misrepresentations of p-values. See Goodman’s article for a discussion of the problems.

After his examination of the key factors contributing the inaccuracy of published research findings, Ioannidis suggested there were several corollaries that followed. Among them were: 1) The smaller the studies conducted, the less likely the research findings will be true; 2) the smaller the effect sizes, the less likely the research will be true; 3) the greater the financial and other interests and prejudices in a scientific field, the less likely the research findings will be true; and 4) the hotter a scientific field (with more scientific teams involved), the less likely the research findings are to be true. The first two could fit within Insel’s issue of flawed experimental design, but not the third and fourth corollaries.

Moonesinghe et al. noted that while they agreed with Ioannidis that most research is false, they were able to show that “replication of research findings enhances the positive predictive value of research findings being true.” However, their analysis did not consider the possibility of bias in the research. They commented how Ioannidis showed that even a modest bias could decrease the positive predictive value of research dramatically. “Therefore if replication is to work in genuinely increasing the PPV of research claims, it should be coupled with full transparency and non-selective reporting of research results.”

While not everyone is supportive of the idea, open access within peer-reviewed scholarly research would go a long way to correcting many of these problems. Starting in January of 2017, the Bill & Melinda Gates Foundation will require all of its research to be published in an open access manner. Susannah Locke on Vox cited a chart from a 2012 UNESCO report that showed where scholarly publications in clinical medicine and biomedicine have typically been less available for open access than other scientific fields. Access to psychology research began a downward trend in 2003 and was no better than the average for all fields by 2006.

There is a growing movement to widen Open Access (OA) to peer-reviewed scholarly research. The Budapest Open Access statement said by ‘open access’ they meant “its free availability on the internet, permitting any user to read, download, copy, distribute, print, search, or link to the full texts of these articles.” Francis Collins, in an embedded video on the Wikipedia page for “Open Access” noted the NIH’s support for open access. Effective on May 8, 2013, President Obama signed an Executive Order to make government-held data more accessible to the public.

Many of the concerns with academic research discussed here could be quickly and effectively dealt with through open access. The discussion of the “First Blood Test Able to Diagnose Depression in Adults,” looked at in “The Reproduciblity Problem,” is an example of the benefit and power it brings to the scientific process.  There is a better future for academic research through open access. It may even knock publication bias out of the academic journals.

02/9/15

Evolution of Synthetic Painkillers

The documentary, “American Addict” (available on Netflix) reported that 106,000 Americans die from prescription drugs each year. In the first six months of 2008, 67% of the oxycodone that was prescribed throughout the U.S. came out of Broward County Florida. What was going on? Mid Eastern states had a prescription drug-monitoring program; Florida didn’t.  Drug seekers from those states went south for their drugs.

By the end of the 1800s, a wide variety of “patent medicines” had come onto the market. They were called “patent” medicines because their formula was a secret; so the ingredients weren’t listed. “Some of the patent medicines were up to 50% morphine by volume. And no matter what ails you, if you take something that is 50% morphine by volume, you’re going to feel better.” And some people began to use opiated “cure-alls” as intoxicants. These cure-alls were popular among women. “The typical opiate user in the nineteenth century was a middle class, middle–aged, white woman living in the middle of the country,” according to Pat Morgan of UCLA.

When Congress passed the Pure Food and Drug Act of 1906, it required the patent medicine industry to label its ingredients. “As a result of these regulations, most of the patent medicines went out of business immediately.” Addiction decreased dramatically; as a result of Americans becoming aware of what these drugs could do, according to historian Cliff Schaffer. But heroin addiction was just coming into its own (See another article, “Legacy of the ‘Joy Plant’”).

By 1913, heroin replaced morphine as the leading cause of hospital admissions for narcotics problems in the US. It was the leading drug of abuse in New York City. In 1914 the federal government passed the Harrison Tax Act. This legislation required an opiate prescriber to get a license and pay a tax; and an opiate user had to be a patient of a licensed prescriber. It created an estimated 100,000 to 200,000 criminals out of users and addicts. Heroin eventually became an illicit substance in 1924 with the Heroin Act, which made it illegal to manufacture, possess or distribute heroin—even for medical use. But the chemists of the world were already working to develop synthetic substitutes.

Oxycodone was first synthesized in 1916 at the University of Frankfurt. It was hoped that it could be a less addictive substitute for morphine and heroin. By the 1920s, there were reports of “euphoric highs” in patients using oxycodone. It was first introduced to the US in 1939. In the early 1960s, the US classified it as a Schedule II drug.  In 1950, Percodan (oxycodone and aspirin), was put on the market by Endo Pharmaceuticals. In 1971, Percocet (oxycodone and acetaminophen) was launched by Endo Phrmaceuticals. In 1996, OxyContin, a time-release form of oxycodone became available from Purdue Pharmaceuticals.

The time-release mechanism that was supposed to make OxyContin more difficult to abuse was quickly and easily neutralized by crushing the tablet before snorting the powder or mixing it with water to inject it. Users compare the high from oxycodone to heroin. In 2010, an abuse-deterrent formulation of OxyContin was introduced. The intent was to make it more difficult to crush. The New England Journal of Medicine published an article, “Effect of Abuse-Deterrent Formulation of OxyContin” in July of 2012 that indicated the new formula did indeed decrease it as a drug of abuse. But 24% of those who had abused OxyContin reported they found a way to defeat the tamper-resistant properties. Sixty-six percent reported switching to another opioid, with heroin being the most common choice. Heroin is easier to use, cheaper and easily available. The article concluded “Abuse-deterrent formulations may not be the “magic bullets” that many hoped they would be.”

Not to be deterred by these conclusions, Purdue Pharmaceuticals recently received approval for Terginiq ER, a combination of oxycodone and naloxone, a drug that is supposed to block the euphoric effects of oxycodone if it is crushed (so it can’t be snorted or dissolved and injected). But if you simply swallow Teriniq ER, the naloxone is not activated. “When the pills are swallowed they are as addictive as pure oxycodone.” Nevertheless, the FDA sees the approval of abuse-deterrent medications like Targiniq ER as a positive step in its fight address the public health crisis of prescription drug abuse in the U.S.

Hydrocodone was first synthesized in 1920, of course, by Germans. In 1924, it was first sold by Knoll Pharmaceuticals in Germany as Dicodid. Knoll was also responsible for the introduction and marketing of oxycodone as Dinarkon in 1917, and Dilaudid (hydromorphone), in 1926. Through a series of mergers, Knoll became a part of Abbott Laboratories in June of 2002.

In 1929, the U.S. Bureau of Social Hygiene gave the National Research Council several million dollars to study various new compounds like hydrocodone, to see if there was a less addictive opioid than morphine or heroin. Nathan Eddy tested the safety, efficacy and side effects of 350 drugs, including morphine, codeine, Dilaudid and hydrocodone. His results showed that hydrocodone was an effective painkiller, with predicable side effects. It also “induced euphoria, and therefore there was a danger of addiction.” Eddy said that tolerance developed more slowly than with morphine or Dilaudid and the occurrence of abstinence syndromes were less severe than with other drugs. This suggested an individual could become dependent on it without knowing it until they are really hooked.

With the Controlled Substances Act of 1971, pure hydrocodone was classified as a Schedule II controlled substance, as was opium and morphine. But in combination with other drugs, it could be regulated as a Schedule III drug. In 1978, Knoll Pharmaceuticals introduced Vicodin, five milligrams of hydrocodone with 500 milligrams of acetaminophen. Generic Vicodin became available in 1983.

Hydrocodone had become the most prescribed medication in the U.S. “Since 2007, more U.S. prescriptions were written for hydrocodone + acteminophen than any other drug.” In 2012 alone, there were over 135 million prescriptions written.

In 2002, emergency room reports involving hydrocodone had increased by 500% since 1990. That same year, the FDA recommended tighter warnings on drugs containing acetaminophen because of the concerns it can cause liver damage. In October of 2014, Vicodin was reclassified as a Schedule II drug. The purpose of the change was to minimize its use as a recreational drug, while ensuring that patients with severe pain still have reasonable access.

A new hydrocodone painkiller called Zohydro, with 5 to 10 times the power of Vicodin, was approved by the FDA in October of 2013. This approval ignored the 11 to 2 vote AGAINST APPROVAL by its own advisory panel. Zohydro is pure hydrocodone. Melanie Haiken, a contributor to Forbes, wondered if we need a new opiate painkiller, given that we don’t seem to be able to prevent the ones we already have from ending up in the wrong hands. She commented: “The U.S., with just 5 percent of the world’s population, now accounts for 84 percent of global oxycodone (OxyContin) consumption and more than 99 percent of hydrocodone (Vicodin, Lortab) consumption. That’s a lot of painkillers.”

02/6/15

Turning to God in Repentance

In The Confessions, Augustine famously prayed as a young man of nineteen for God to grant him the gift of chastity, “but not yet.” Augustine said he was afraid that God would deliver him from lust too quickly, “which I desired to have satisfied rather than extinguished.” God “granted” his prayer and it wasn’t for another twelve years that Augustine finally converted to Christianity. In the meantime, he fathered a child by a mistress and spent a few years within the heretical sect of Manichaeism. What seems to have been missing for him at the time was a turning to God in true repentance.

In The Doctrine of Repentance, Thomas Watson said: “Repentance is a grace of God’s Spirit whereby a sinner is inwardly humbled and visibly reformed.”  He went on to discuss what he described as a recipe with six special ingredients for true repentance: 1) the sight of sin; 2) the sorrow for sin; 3) the confession of sin; 4) shame for sin; 5) hatred for sin; and 6) turning from sin. He warned that if any one of them was left out, “repentance loses its virtue.”

So far we’ve looked at the first three ingredients in “On the Road to True Repentance” and “Confession and True Repentance.”  We’ve also seen what Watson thought about “Counterfeit Repentance.” Here we will look at the last three ingredients, with special emphasis on turning from sin.

Watson said it was a great shame not to be ashamed of our sin. If the sins of the godly are mentioned at all on Judgment Day, it will not be to shame them, but to show the riches of God’s grace in pardoning them. Shame for sin is the shame of realizing we were like beasts when we sinned—dogs that returned to their vomit; or pigs wallowing in the mud after they were washed (2 Peter 2:22). “God’s image is defaced, reason is eclipsed, and conscience is stupefied.”

“A true penitent is a sin-loather.” Their spirit is set against it. They hate all sin, for “sin leaves a stain upon the soul.” If you love sin instead of hating it, you are far from repentance. “To the godly, sin is a thorn in the eye; to the wicked, it is a crown on the head.” Sin reaches our soul. By sin we have lost our innocence. Our hatred of sin should be infinitely greater than our love for it ever was. Clearly Augustine at nineteen did not hate lust more than he loved it. He also did not turn from it.

In true repentance, we recognize our sin; we sorrow for our sin; we confess our sin; we are ashamed of our sin; and we hate our sin. These then lead us to the final ingredient: turning from sin. The day we turn from sin, we must commit to a perpetual fast from sin—“Dying to sin is the life of repentance.” Turning from sin should be so visible, that others see it. It’s as if another soul has lodged in the same body.

Our turning must include our hearts—not just our behavior. “The heart is what the devil strives hardest for.” Every sin is to be abandoned; every lust is to be destroyed. “Someone who indulges one sin is a traitorous hypocrite.” An individual may restrain from sin out of fear or design, but a true penitent does so because of their love for God. If sin were not such bitter fruit, if death were not it consequence, “a gracious soul would forsake it out of love for God.”

Turning from sin means a turning to God. “Unsound hearts pretend to leave old sins, but they do not turn to God or embrace his service.” True turning from sin means there is no returning. Returning to sin gives the devil more power than before. “A true turning from sin means divorcing it, so as never to come near it any more.”

Some people are only half-turned—they turn in their judgment, but not in their practice. They acknowledge the power of sin over them, and even weep over it. But they are “so bewitched by it that they have no power to leave it.” In this sense, they are powerless over it; the corruption of their sin is stronger than their convictions. Others are half-turned when they turn from many sins, but remained unturned from some special sin.

“If we turn to God, he will turn to us. He will turn his anger from us, and turn his face to us. It was David’s prayer, “O turn to me, and have mercy upon me” (Ps. 86.16). Our turning will make God turn: “Turn to me, says the Lord, and I will turn to you” (Zech. 1.3). The one who was an enemy will turn to be our friend.”

It could be that at nineteen, Augustine was only half-turned from lust. Through the graciousness of God, he did not remain half-turned, but became one of the most learned and important of the church’s theologians. Within his Book of Meditations, he wrote a “Prayer for the Gift of Tears,” asking that God would take from him whatever “offends the eyes of Thy goodness.”  God alone can renew what is ruined and fallen. Augustine prayed that God would pour into his heart the fullness of His love, so that he would not think of or desire what was carnal or earthly. “But rather love Thee alone.”  This was a full turning to God.