03/30/15

Killer Caffeine

© : Santi Sinsawad | 123RF.com

© : Santi Sinsawad | 123RF.com

I knew of a woman who had a dual addiction to marijuana and caffeine. Yes, caffeine. She drank several pots of coffee throughout the day along with smoking marijuana. While a resident in a long-term rehab for women, she repeatedly denied that she had caffeinated coffee. But the staff “knew” she was somehow getting it and using it because of the coffee stains on the rug in her room. Several room searches were done to no avail. Finally she was busted. What the woman had done was smuggle a Melita filter and caffeinated coffee into the facility when she out for an appointment. In all the years I’ve worked with substance use/abuse disorders, this was the only time I’d ever seen such classic addictive behaviors with caffeine.

The last several years have seen the marketing of energy drinks with high caffeine content, and the use of products like 5-hour ENERGY “shots.” Many of the individuals I meet in early recovery are drawn to energy drinks, so I’ve been watching for news and research on them. I’ve heard of some concerns about their safety. And recently I heard about powdered caffeine. Just one teaspoon contains 3,200 mg of caffeine.

So let’s start with some basic information about caffeine before we get to the reported deaths from using caffeine powder. According to Wikipedia, caffeine is the world’s most widely consumed psychoactive drug. It is legal and unregulated in most countries worldwide. In North America, 90% of adults consume caffeine daily. I am one of them. A seven-ounce cup of coffee contains 80 to 175 mg of caffeine, depending upon how it is prepared (drip, percolation or espresso). Toxic doses of caffeine for an adult are over 10 grams—twenty times higher than the average consumption of 500 mg per day.

Caffeine’s positive effects have to do with reducing fatigue and preventing drowsiness. It can even stimulate faster and clearer thought flow, increased focus and better general body coordination. Consistent with this last effect, moderate doses of caffeine can improve athletic performance, but the improvements are not usually substantial. There can be some undesired effects, such as mild anxiety, insomnia, and jitteriness. Although there are caffeine-induced disorders in the DSM-5, caffeine use is usually not considered to be addictive.

Caffeinism can occur when 400 to 500 mg at one time, or 1,000 to 1,500 mg per day or more of caffeine is consumed. Winston et al. noted that the symptoms that occur (restlessness, agitation, excitement, rambling thought and speech, and insomnia) overlap with those of several psychiatric disorders. Extreme overdose can result in death. The estimated lethal dose in humans is estimated to be equivalent to 150 to 200 milligrams per kilogram of body mass; the caffeine in roughly 80 to 100 cups of coffee for an average adult. You can read further about caffeine in a 1981 article, “Caffeine: Psychological Effects, Use and Abuse.” As always with psychoactive substances, you can also see what Erowid has to say about caffeine.

Now, let’s look at caffeine powder. In May of 2014, 18-year-old Logan Stiner died after ingesting 23 times the amount of caffeine found in a typical cup of coffee. Given the above noted information, Logan would have consumed 1,850 to 4,025 mg of caffeine.  While the estimated lethal dose given above would seem to be higher than Logan’s intake of caffeine powder, he still clearly consumed roughly four to eight times the dose needed for caffeinism. Several reports have indicated that a teaspoon of caffeine powder, the equivalent of 25 cups of coffee, can be lethal. Logan’s use of caffeine powder did approach that level. Caffeine powder is a pure chemical. And as Mary Clare Jalonick reported:  “the difference between a safe amount and a lethal dose is very small.”

The FDA has warned against the use of powered pure caffeine. They are particularly concerned about Internet sales of bulk bags of it. “Pure caffeine is a powerful stimulant and very small amounts may cause accidental overdose. Parents should be aware that these products may be attractive to young people.” Michael Landa, the Director of FDA’s Center for Food Safety and Applied Nutrition, reported having a December 2014 meeting with Logan’s parents and the parents of a 24-year-old who died after ingesting powdered caffeine. He said:

I cannot say strongly enough how important it is to avoid using powdered pure caffeine. The people most drawn to it are our children, teenagers, and young adults, especially students who want to work longer to study, athletes who want to improve their performance, and others who want to lose weight.

The FDA doesn’t have the legal authority to just pull these products off the shelf. Caffeine powder is sold as an unregulated dietary supplement—unlike caffeine added to soda and other drink products. This is a common way of getting around regulation with several other potentially harmful psychoactive substances (see Krypton Can Kill You; Kava is not a Magic Bullet).

Michael Taylor, the FDA’s deputy commissioner of foods, said it was inherently irresponsible to market such a potentially dangerous product. “I would hope that people would get the message that they just ought to stop selling it.” So far, they don’t seem to be getting that message.

David Templeton, of the Pittsburgh Post-Gazette, reported that six senators have sent a letter to the FDA urging them to ban the retail sale of caffeine powder. The letter stated that pure caffeine is unsafe. Overdosing is easy and virtually unavoidable. Powered caffeine sold in bulk was said to be markedly different than other caffeine products, on the market, such as energy drinks, energy shots and others. “Because of the risk powdered caffeine poses to consumers, these products merit swift and significant action by the FDA.” The Council of Responsible Nutrition, a trade association for the supplement industry, recently stated their support for an FDA ban against the retail sale of caffeine powder. NutraKey, a major online marketer of caffeine powder did not respond to requests for comment.

03/27/15

Present and Future Blessings

© Bruce Rolff | 123RF.com

© Bruce Rolff | 123RF.com

The Beatitudes are named and structured after the Greek word makarios, meaning someone who is the privileged recipient of divine favor. It is also a literary form found in both the Old and New Testaments. For example, the book of Psalms opens with a beatitude: “Blessed is the man who walks not in the counsel of the wicked, nor stands in the way of sinners, nor sits in the seat of scoffers; but his delight is in the law of the Lord, and on his law he meditates day and night.” The greatest concentration of beatitudes in the Old Testament is within the Psalms and the Wisdom literature. Robert Guelich indicated there were 44 examples of beatitudes in the New Testament, primarily in the gospels of Matthew and Luke.

Jesus begins his teaching in the Sermon on the Mount by underlining the various ways his disciples have and will receive divine favor. Both the poor in spirit (5:3) and those who are persecuted for righteousness’ sake (5:10) receive the kingdom of heaven now, in this present time. The others—in between—have a future promise of fulfillment. Beginning and ending with the same expression is a stylistic device called an inclusion, according to D.A. Carson. So then the present and future blessings are all part of the same theme—the kingdom of heaven. Craig Blomberg said: “Complete fulfillment of Jesus’ promises often requires waiting for the age to come.”

Implied in the Greek word for blessing, is having a right relationship with God and enjoying fellowship with Him. Instead of focusing on what we are to do, the Beatitudes describe the blessings. The obligations or expectations in this relationship come later on in the Sermon on the Mount. Sinclair Ferguson commented that the blessings also weren’t new teaching or revelation. Jesus took some of the themes from the Psalms and Isaiah and applying them to the disciples. “He was pointing out what God’s word tells us is the blessed life.”

Several commentators have noted where Matthew has eight beatitudes, Luke’s Sermon on the Plain only has four (Luke 6:20-22). Another difference is how Matthew’s blessings are all in the third person (5:3-10), where Luke’s are in the second person. Biblical scholars have given a variety of explanations, but it seems to me the best is to see the two sermons not as edited versions of the same one, but as two occasions where Jesus used the “beatitude” approach. So those who receive divine favor are poor in spirit, mourners, meek, hungering and thirsting for righteousness, merciful, pure in heart, peacemakers, and persecuted.

The poor in spirit are those who recognize their spiritual bondage. They are conscious of their sin debt, which separates them from God. All they can do is “cry for mercy, and depend upon the Lord.” D.A. Carson said poverty of spirit was: “The personal acknowledgement of spiritual bankruptcy. . . . The conscious confession of unworth before God.” Note how Carson’s thoughts reflect the process of coming to believe in the first two Steps.

Poverty of spirit becomes a general confession of a man’s need for God, a humble admission of impotence without him. Poverty of spirit may end in a Gideon vanquishing the enemy hosts; but it begins with a Gideon who first affirms he is incapable of the task [powerless], and who insists that if the Lord does not go with him he would very much prefer to stay home and thresh grain.

The mourners grieve the evil and sin they see in themselves and the world around them. The meek are “humble, gentle and not aggressive.” These are not typical qualities of the movers and shakers of this age. But in the age to come, they will lead the meek to come into the possession of what the movers and shakers sought to possess in this age—the earth.

Meekness as humility is throughout the A.A. Big Book. Bill W. said that when making a Third Step with an understanding person, if it was “honestly and humbly made,” it could sometimes have a very great effect at once. Working the Steps meant relying upon God rather than ourselves. “To the extent that we do as we think He would have us, and humbly relay on Him, does He enable us to match calamity with serenity.” The process of the first three Steps is one of admitting spiritual bondage to alcohol and turning it over to God. The Third Step prayer in the Big Book reads:

God, I offer myself to Thee—to build with me and do with me as Thou wilt. Relieve me of the bondage of self, that I may better do Thy will. Take away my difficulties, that victory over them may bear witness to those I would help of Thy Power, Thy Love, and Thy Way of life. May I do Thy will always!

By combining hunger and thirst in 5:6, Jesus intensifies the sense of longing after righteousness—the quality of judicial correctness or justice, with a focus on redemptive action. This righteousness is then seen in granting mercy to others; being pure in heart; being a peacemaker.

Mercy is being concerned about other people in their need; being compassionate. Those who show others mercy will be granted mercy. The final judgment comes to mind here: “Truly I say to you, as you did it to one of the least of these my brothers, you did it to me” (Matthew 25:40).

In January of 1953, a man in the Huntsville Texas prison reflected in the Grapevine (“From Within These Walls”) on how A.A. helped him and others gain a new conception towards those who were distressed. He said the alcoholic prisoner tended to look upon the world through “a mist of resentments.” The desire for revenge poisoned the life of the person who cherished it. Revenge begets revenge, he said. “While forgiveness melts the stony heart and brings reconciliations.” If anyone were to ask him what was the most inherent and conclusive proof from the Gospels that Jesus understood humanity, he would point to the Beatitude: “Blessed are the pure in heart, for they shall see God.”

Being pure was to be free from moral guilt. Leon Morris noted this is the only time in the New Testament where purity is predicated of the heart. “To be pure in heart is to be pure throughout.” And in the age to come they will see God, reversing the separation to goes back to the Garden of Eden. The Greek word for peacemaker occurs only here in the New Testament and refers to someone who works to restore peace between people; who seeks reconciliation or amends with others. They will be called sons of God. Craig Blomberg said: “Others will identify them as God’s true ambassadors, as those being conformed to his likeness.”

Becoming a peacemaker is embedded within the Eleventh Step. In Twelve Steps and Twelve Traditions, Bill W. suggested the St. Francis Peace Prayer as a beginning for meditation and prayer in Step Eleven  (See “Make Me an Instrument of Your Peace” for more on the Peace Prayer and A.A.)

There are many other ways that the Beatitudes and 12 Step recovery are associated. If you start your own study, you will discover them. This is part of a series of reflections dedicated to the memory of Audrey Conn, whose questions reminded me of my intention to look at the various ways the Sermon on the Mount applied to Alcoholics Anonymous and recovery. If you’re interested in more, look under the category link “Sermon on the Mount.”

03/25/15

Murphy’s Law

© Icefields | Dreamstime.com

© Icefields | Dreamstime.com

In December of 2013, Congressman Tim Murphy, a Republican representing the 18th District of Pennsylvania, introduced H.R. 3717, the Helping Families in Mental Health Crisis Act. You can red a shorter summary of it here. Almost immediately, it drew opposition from several advocacy groups. H.R. 3717 says it’s purporse is: “To make available needed psychiatric, psychological, and supportive services for individuals diagnosed with mental illness and families in mental health crisis, and for other purposes.” Why would advocates for the mentally ill be opposing a bill that is supposed to help the mentally ill?

One of these was MindFreedom, a nonprofit organization that seeks to nonviolently unite “people affected by the mental health system with movements for justice.” MindFreedom noted that the bill eliminated legal advocacy on behalf of those with psychiatric disabilities. It cut 85% of the existing funding for protection and advocacy programs. Under the bill individuals with psychiatric disabilities won’t get the same HIPPA protections. It would increase institutionalization, giving more money to psychiatric institutions than programs to help people live within the community.

A press release from the Mental Health Advocates suggested the measure would reverse some of the advances of the last 30 years in mental health services and supports. “It would exchange low-cost services that have good outcomes for higher-cost yet ineffective interventions.”  The bill was said to target the rights of individuals with mental illnesses and restructure federal funding “to heavily encourage the use of force and coercion.” It would seek to expand involuntary outpatient commitment (IOC), where an individual with serious mental illness would be court-mandated to follow a specific treatment plan, typically requiring medication.

Several bloggers for Mad in America also voiced their opposition to the legislation. Corinna West said the bill “replaces peer support, which works, with forced treatment, which doesn’t.” She cited the National Association of State Mental Health Program Directors, who after a review of forced treatment found it wasn’t helpful. Additionally, peer support was the #1 most effective method. She also noted in her December 2013 article that two of the top five industries donating to Rep. Murphy’s reelection campaign were healthcare professionals and the pharmaceutical industry. We’ll return to this issue later.

Faith Rhyne noted the legislation presented itself as having “worst case scenarios in mind;” that it was “not about most people” with psychiatric diagnoses. However, the criteria in the bill for patients eligible for IOC are not limited to individuals with a history of violence and incarceration. “It includes those with a record of non-medical hospitalizations,” and those deemed unable to care for their basic needs. “In many ways the legislation carries the theme and intent of E. Fuller Torrey’s Treatment Advocacy Center, which is noted on Representative Murphy’s website as being a leading supporter of the bill.”

Mad in America wrote an editorial opposing the bill, focusing on the dangers of the mandated treatment relying on antipsychotic medication. The editorial referred to research showing that these medications shrink the brain and may actually impair recovery. “But American psychiatry and the NIMH have never publicized those findings.” The false impression of the benefits of antipsychotics made passage of H.R. 3717 possible.

The House Subcommittee on Health held a hearing on H.R. 3717 on April 3, 2014. You can watch a video of the hearing and review documents associated with it here. Still trying to gain support for the bill, Rep. Murphy addressed the American Psychiatric Association in May of 2014. In his introduction, he was called “a friend of psychiatry.” He gave an impassioned plea of support for his “comprehensive mental health legislation.” The APA President, Paul Summergrad said:

The APA is committed to achieving needed legislation to transform mental health care on the basis on the best science and clinical care. We are pleased to work closely with Representative Murphy as well as Representative Barber and others to craft the best bill to benefit the American people.

Elise Viebeck reported for The Hill that House Republican leaders announced in June of 2014 they were going divide the Murphy Bill into pieces in an attempt to pass the less controversial provisions. This was said to be a major blow to the bill and Rep. Murphy, who had argued that only “dramatic and comprehensive reform” would help people with serious mental illness. “The defeat of the comprehensive bill is a victory for the broad swath of national mental health groups that were uneasy about or opposed to Murphy’s legislation.”

But Murphy continued to lobby for support of his comprehensive bill.  A December 2014 updated summary of H.R. 3717 listed 34 organizations supporting the bill, including the American Psychiatric Association and the American Psychological Association and the Treatment Advocacy Center. There were 115 cosponsors of H.R. 3717.  The twenty-one media outlets included: The Wall Street Journal, The Washington Post, the Pittsburgh Post-Gazette, the Seattle Times, and the Houston Chronicle.

In February 2015, Congressman Tim Murphy was a keynote speaker at an event, “Fixing America’s Mental Healthcare System.” He said he hoped to reintroduce H.R. 3717 as early as March of 2015. Senator Chris Murphy, who participated in the same panel discussion event as Congressman Murphy, voiced his intent to introduce similar legislation in the Senate this year. Senator Murphy is from Connecticut, where the Sandy Hook shooting took place.

Rob Wipond of Mad in America, citing a 2013 analysis of the bill by the National coalition for Mental Health recovery, once again noted how the existing legislation would “heavily encourage the use of force and coercion.” This would likely involve “treating people with pharmaceuticals. It would undermine the rights and legal support of people seeking non-drug options. It would cut funds for community-based services with a proven track record of helping people stay out of the hospital. “(T)his bill would cost more money for worse outcomes.”

Wipond also cited information on donors to Congressman Murphy for the 2014 election cycle. Maplight listed contributions from pharmaceutical companies such as: GlaxoSmithKline, AstraZenaca, Pfizer, Johnson & Johnson, Merck & Co, Eli Lilly & Co.—many of them on multiple occasions.  Murphy received $95,830 from 10/1/2012 to 9/30/2014 from pharmaceutical/health care product companies.

OpenSecrets.org reported that within Murphy’s top 20 contributions from industry were health professionals, pharmaceuticals/health products, hospitals/nursing homes, and health services/HMOs. Murphy received over $283,000 from the political action committees related to these industries for the 2014 election cycle. There were individual contributions in addition to these. His campaign committee reported that during the 2013-2014 fundraising cycle they raised $1,854,010. In his political career from 2001-2014, he has received $701,235 in contributions from health professional political action committees, and $430,030 in contributions from pharmaceuticals/health products political action committees.

In all the readings linked here; in the videos I watched of Congressman Murphy gathering support for his bill, I did not hear any substantive reference made to the concerns raised and noted above by MindFreedom, Mental Health Advocates, or Mad in America. Specifically, I did not hear anything addressing the concern for the proposed IOC.

Congressman Murphy advocates for increased social control over individuals with “mental illness.” He’s a friend of psychiatry, who dismissed the opponents to his legislation as marginal and “anti-psychiatry” in his rhetoric to the American Psychiatric Association. He is passionate in his views and has a well-polished stump speech that he gives as he drums up support for his legislation. He has been heavily supported by the medical and healthcare industry throughout his political career. And he is getting ready to try again to get Congress to approve legislation giving psychiatry increased power and authority.

This is happening just as the validity of what he has referred to as “anti-psychiatry” is becoming more widely known and accepted. What’s more, there is scientific evidence to support much of it. The evidence-based “treatment” of psychiatric medications has been repeatedly shown to be marginally effective at best. Look at the information on Mad in America; Psychiatric Drug Facts and PsychRights.

Any legislative reform that gives psychiatry more power should be sidelined until the existing questions on the validity of psychiatric diagnosis and practice are resolved. Otherwise, we may have to live with the consequences of a different Murphy’s law—anything that can go wrong, will go wrong. If we really want to help the “mentally ill,” we should wait until we are clear that the proposed changes will help and not harm them.

03/23/15

Stinkin’ Thinkin’ Addiction

© Gennadiy Kravchenko | 123RF.com

© Gennadiy Kravchenko | 123RF.com

“Most Substance-addicted people are also addicted to thinking, meaning they have a compulsive and unhealthy relationship with their own thinking.” (David Foster Wallace, Infinite Jest)

Once a person becomes dependent upon a drug there is a tendency to transfer that addiction to other mood-altering substances. This is what is meant by cross addiction. If an individual becomes addicted to one drug, they can rapidly develop an addiction to another drug in that class of drugs. The reason is mostly physical. The body becomes accustomed to the effects of one kind of drug and will have an affinity to drugs that are similar. “Cross addiction occurs because all addictions work in the same part of the brain.” For an in-depth examination of the neurobiological factors underlying drug addiction and relapse, read “Neuroplasticity in Drug Addiction” on “Terry Gorski’s Blog.”

A chemically dependent person who comes to rely on a particular drug may, for various reasons, decide to abstain from that drug. If they substitute something else, it may not be as effective as the original drug of choice was for them. This can lead to thinking about or craving the original drug. Intoxication with the substitute drug that results in impaired thinking could lead them to use their primary drug again. You don’t have to be incredibly intoxicated either. You just have to be high enough to want your drug of choice and be willing to act on the impulse.

Alisha celebrated a years worth of clean time since she stopped using cocaine. She went out to dinner with a guy on a first date. He must have wanted to impress her, because he’d taken her to a very nice restaurant. He didn’t know about her history and ordered a bottle of wine. Alisha didn’t see the harm in having a glass or two of wine; alcohol had never been her thing. In the middle of the dinner she excused herself and called her cocaine dealer from the bathroom.

In The Science of Addiction, Carleton Erickson said that cross-dependence or cross-tolerance occurs between drugs within the same class. So when a person becomes dependent upon one benzodiazepine, they are dependent upon other benzodiazepines. “It is also possible for a person to be cross-tolerant to drugs of different classes.” One example could be benzodiazepines and alcohol.

Cross-dependence between classes occurs as well. “Reports suggest that such cross-dependence occurs between alcohol and cocaine, alcohol and nicotine, alcohol and benzodiazepines, and heroin and cocaine.” Terence Gorski suggested that this cross-dependency is likely to develop gradually. Early in my professional career I referred a heroin addict to an inpatient detox and rehab program, expecting that the individual would be referred back once the inpatient treatment was completed. In their infinite wisdom, the treatment staff referred the man to a methadone clinic. Two or three years later, he came back to my outpatient program, but not for heroin. He never resumed using heroin. Now he had a serious alcohol problem. What started out as a few drinks to take the edge off became a full-blown alcohol dependency problem.

Substance use disorders cannot be effectively treated as if each one is a discrete disease entity. Stable, long term sobriety is only possible if the person lays a foundation of abstinence from all addictive drugs and then works through the personal and social dysfunction that inhabited their life concurrently with their substance use. Sobriety is not simply whether or not you are drinking or using drugs. A relapse begins sometime before the individual resumes active drinking or drug use. Terence Gorski has said:

Sobriety is abstinence from addictive drugs plus abstinence from compulsive behaviors plus improvements in bio-psycho-social health. Sobriety includes all three things. To the extent that you have accomplished those three things you are sober; to the extent that you have not accomplished those three things you are not sober.

The grey area between initial abstinence and sobriety is where cross-addictions develop. These substitutes can be other chemicals or compulsive behaviors—what Gorski referred to as “process addictions.” These compulsive behaviors/process addictions will typically fall into eight types: 1) eating/dieting; 2) gambling; 3) working/achieving; 4) exercising; 5) sex; 6) thrill seeking; 7) escape; 8) spending.

Compulsive behaviors are actions that can produce excitement or emotional release, what Gorski called an addictive brain response. “This means that the brain is flooded with pleasure chemicals that create a unique sense of euphoria while being inhibiting from producing warning chemicals which cause the feelings of stress, anxiety, fear, and panic.” So these triggers initiate a neurochemical reaction that reinforces the person to keep pulling the addictive trigger.

Evidence supportive of this view is found in the treatment of pathological gambling with the opiate antagonist, naltrexone (here). Piz et al. published a case report where a patient with a compulsive gambling problem avoided a resumption of gambling for three years while taking naltrexone.

Many people begin with a chemical addiction and in sobriety “crossover” or “migrate” into a process addiction. In his book, Staying Sober, Terence Gorski noted how the same behaviors could be compulsive, process addictions or positive outlets. “Every behavior that can be used compulsively, can be productive if used in a way that does not result in long-term pain or dysfunction.” A behavior that is used compulsively is used as some people use drugs—to alter mood, turn off mind and evade reality. Behaviors are positive outlets when they enhance reality and help a person to cope more effectively with reality.

I have read and used Terence Gorski’s material on relapse and recovery for most of my career as an addictions counselor. I’ve read several of his books and booklets; and I’ve completed many of his online training courses. He has a blog, Terry Gorski’s blog, where he graciously shares much of what he has learned, researched and written over the years. This is one of a series of articles based upon the material available on his blog and website.

03/20/15

The Architektōns of God

© tessarthetegu | 123RF.com

© tessarthetegu | 123RF.com

In 2003 a team of Israeli archaeologists doing a geophysical survey of the south-western part of Sea of Galilee discovered a huge cone-shaped structure underwater. It is 230 feet in diameter and about 39 feet high. The cairn is made of basalt boulders with no apparent construction pattern. The boulders have no signs of cutting or chiseling. There is no evidence of arrangement or walls within the structure.

The archeologists speculated that it could have been built on shore at a time when the water level of the Sea of Galilee was significantly lower than it is today. Or it could have been built to function as it does now as a habitat for fish; an ancient fish nursery. Its size suggests that a “complex, well-organized society, with planning skills and economic ability” built it more than 4,000 years ago. So far, no excavation of the site has been done. If you want, read the original journal article: “A Submerged Monumental Structure in the Sea of Galilee, Israel.”

We live in a time when the wonder of such an accomplishment is an everyday occurrence. Most medium sized cities around the world have structures that reach the mass of this 60,000-ton pile of rocks. We even have sea-going vessels that meet and surpass its tonnage. And yet it still bears the undeniable evidence thousands of years later that a group of humans came together and built it.

I think that one of the negative consequences of this capability in modern culture is that we miss the excitement and wonder intended when Scripture uses building or architectural metaphors to describe the work of building the kingdom of God. The gospel of Matthew (21:42) tells of Jesus quoting Psalm 118:22 as he gave a series of parables in response to the religious leaders questioning where he received the authority to do and say the things he did.

I imagine Jesus replied to them with some incredulity in his voice, haven’t you read in Scripture: “The stone that the builders rejected has become the cornerstone; this was the Lord’s doing and it is marvelous in our eyes?” He then told them that because of their rejection of him—the cornerstone provided by God, the kingdom they had been building would be taken from them and given to another people.

More than that, this stone (Jesus himself) was a stumbling stone. Since they rejected the cornerstone from God, their foundation was unstable. Instead of acting as a sure foundation upon which to build their spiritual existence, their building would fall. And when it fell, it would crush them (Matthew 21:44). There is an allusion by Jesus here to two verses in Isaiah, 8:14 and 28:16:

And he will become a sanctuary and a stone of offense and a rock of stumbling to both houses of Israel, a trap and a snare to the inhabitants of Jerusalem. (Isaiah 8:14)Behold, I am the one who has laid as a foundation in Zion, a stone, a tested stone, a precious cornerstone, of a sure foundation. (Isaiah 28:16)

Both Peter and Paul understood and used the metaphors of building and cornerstone in their teachings about Jesus and his kingdom.

Peter used the cornerstone and building imagery for his Pentecostal sermon in the book of Acts (4:11); and again in 1 Peter 2:4–8.  There he referred to Christ as a living stone, the “chosen and precious cornerstone.” Believers are living stones as well, being built into a spiritual house. The chosen and precious cornerstone is of course referring to Isaiah 28:16. He stretched the inorganic imagery of the building metaphor by describing its individual components (Christ as the cornerstone and believers as the building stones) as living for a reason.

The inorganic sense of a building fails to grasp the fuller sense of union we have with Christ as a result of his death, resurrection, and the indwelling of the Holy Spirit. Not only do we come together with others to align with the teachings and standards of Christ as do building stones with a cornerstone, but our very lives exist within and through him, “In him we live and move and have our being” (Acts 17:28); “In his hand is the life of every creature and the breath of all mankind” (Job 12:10). Christ and his church are from the same family (Heb 2:11). Our union with Christ is more than the beauty of purpose and design seen in structures like Frank Lloyd Wright’s Falling Waters home. We are alive with Christ; the building is a living structure.

As Craig Keener pointed out in the IVP Background Commentary on the New Testament, the image of a living building of believers was not limited to just Christians. The Qumran community saw itself as a living temple. One text within the Dead Sea Scrolls even speaks of the temple’s individual elements (pillar, foundation, etc.) as living beings. They also applied Isaiah 28:16 to their own leadership.

Paul used the same imagery regularly. In Romans 15:2, he said that pleasing our neighbor for his good was “building him up. ” After we receive Christ (the cornerstone from God), we are to walk in him: “rooted and build up in him” (Colossians 2:6). In 1 Corinthians 3:10-11, he compared himself to a master builder who laid a foundation of faith in Corinth. Someone else was building on it, and Paul cautioned them to take care of how they build. “For no one can lay a foundation other than that which is laid, which is Jesus Christ.”

In Ephesians, Christ is the cornerstone and the apostles and prophets are the foundation of a holy temple. The Ephesians were being built together into a dwelling place for God (Ephesians 2:19-22). Again, the church members are part of God’s building. There is a clear sense of purpose, design and the need for careful alignment with the cornerstone and foundation—so that the dwelling of God is built according to the Designer’s specifications. And today, almost two thousand years after these original builders laid the foundation, that work continues. When we use Jesus Christ as the cornerstone of our lives and our work, we too are architektōns, master builders. And because we build upon a sure foundation, it will last until Christ comes again.

03/18/15

Modern Alchemy with Antidepressants

19867524_sA study published in the open access journal, PLOS One by Sugarman et al. once again replicated previous studies showing that there was very little clinical difference between an antidepressant and placebo. In a way this is old news. One of the study’s authors, Irving Kirsch previously reported these findings. You can read more on this antidepressant research here and here. I’ve also looked at a 60 Minutes broadcast that interviewed him in “Thor’s Psychiatric Hammer: Antidepressants.” Kirsch has also published a book on the topic: The Emperor’s New Drugs: Exploding the Antidepressant Myth. But here is the significance of the Sugarman et al. study. It was the first evaluation to use “a complete database of published and unpublished trials sponsored by the drug’s manufacturer.”

In 2004, GlaxoSmithKline  (GSK) was required as part of a lawsuit settlement to post online the results of all clinical trials involving its drugs. The 2004 lawsuit was because the company had withheld data on the ineffectiveness and potential danger of Paxil (paroxetine) when given to adolescents and children. But it doesn’t seem GSK learned their lesson. In 2014 the company agreed to plead guilty to criminal charges and pay $3 billion in fines for promoting its antidepressant drugs, Paxil and Wellbutrin for unapproved uses and failing to report safety data about Avandia. So Sugarman et al. were able to use the data GSK made available to do the research reported here.

The current analysis is the first evaluation of the efficacy of an SSRI medication in the treatment of multiple anxiety disorders, and the first to utilize a complete database of published and unpublished trials sponsored by the drug’s manufacturer. Our results indicated that paroxetine presented a modest benefit over placebo in the treatment of anxiety and depression, with mean change score differences of 2.3 and 2.5 points on the HRSA [Hamilton Rating Scale for Anxiety] and HRSD [Hamilton Rating Scale for Depression], respectively.

The study’s results found that individuals receiving placebo reported 79% of the magnitude of change with the individuals receiving paroxetine. This was consistent to previously reported magnitudes of 76% for placebo compared to paroxetine. Replicating this previous finding, namely greater than 75% of the drug response, suggested that: “the magnitude of the placebo effect is especially large in the treatment of anxiety and depression.” Given the similarities between paroxetine and other SSRIs, it is possible that similar magnitudes of placebo effects will be found with them. Further research is required to support this proposition. Nevertheless, “the current analysis indicates that the published literature represents an overestimate of the true efficacy of paroxetine in the treatment of anxiety.”

The glass-half-full reporting of the differences between drug and placebo have emphasized that statistically significant differences were found. The problem is, those differences were so small, that their clinical significance was questionable. According to the criteria of NICE, the National Institute of Health and Clinical Excellence, “the mean difference between paroxetine and placebo in the current analyses fell short of clinical significance for the treatment of both anxiety and depression.” Sugarman et al. reviewed these concerns and concluded that changes of three points or less on the HRSD did not correspond to a clinically detectable change and appeared to be “of marginal clinical significance.”

So paroxetine has only a slight benefit over placebo in treating symptoms of anxiety and supports previous work indicating that it has just a modest benefit over placebo when treating depression. Given the known side effects with standard medications used to treat anxiety and depression, their use as a first-line treatment for these problems seems questionable. “The obvious alternative for the treatment of both anxiety and depression is psychotherapy intervention.” But direct comparisons have not generally shown a significant difference between depression treatment modalities (medication or psychotherapy). Similarly inconclusive findings were noted for anxiety treatment.

Allen Frances said there were two differences between medieval alchemy and the pharmaceutical industry today. First is the well-oiled, massively financed, worldwide, and devastatingly effective marketing machine. Second is the requirement for a DSM diagnosis.

A significant portion of the $12 billion spent each year on antidepressants in the United States rewards the drug companies for promoting the overly widespread use of what to many patients are no more than highly advertised, oversold, and very expensive placebos prescribed for a fake diagnosis. (Allen Frances, Saving Normal)

In 2010, there was a study published a Scandinavian psychiatric journal with the provocative title: “Antidepressant Medication Prevents Suicide in Depression.”  It concluded from studying 18,922 suicides in Sweden between 1992 and 2003, “that a substantial number of depressed individuals were saved from suicide by postdischarge treatment with antidepressant medication.” Sixteen months after publication, it was formally retracted by the authors for “… unintentional errors in the analysis of the data.”

Psychologist Phillip Hickey reported that after a five month legal battle, he was able to get access to the correct data. The original study found that among completed suicides treated for depression in psychiatric care in the last five years before their suicide, 164 (15.2%) had antidepressants in their blood when they committed suicide. The corrected data indicated that 603 (56%) had antidepressants in them when they committed suicide. The “unintentional error” was huge—an increase of 439 people (268%).

And yet, the study’s author said that no conclusion from the study could be drawn “regarding antidepressants’ effects on suicide risk in any direction.” In other words, you couldn’t conclude that antidepressants prevented or facilitated suicide risk. Hickey reported that at the time of writing the original article, its author has financial ties to Lundback, Eli Lily and GSK (GlaxoSmithKline).

In another study, found in The British Journal of Psychiatry, a team of UCLA researchers randomized 88 participants into double-blind groups for 8 weeks of treatment (placebo or medication) with supportive care; and a separate group receiving supportive care alone. Expectations of medication effectiveness, general treatment effectiveness and therapeutic alliance were also measured. The groups receiving medication or placebo plus supportive care were not significantly different. However, both had significantly better outcomes than the supportive care alone group. Expectations of medication effectiveness were predictive of only the placebo response. Therapeutic alliance predicted participant response to both medication and placebo.

The lead author of the study, Andrew Lechter, said that the results indicated that if you think a pill is going to work, it probably will work. He noted that belief in the effectiveness of the medication was not related to the likelihood of benefitting from it. “Our study indicates that belief in ‘the power of the pill’ uniquely drives the placebo response, while medications are likely to work regardless of patients’ belief in their effectiveness.” He speculated that factors like direct-to-the-consumer advertising could be shaping peoples’ attitudes about medication. “It may not be an accident that placebo response rates have soared at the same time the pharmaceutical companies are spending $10 billion a year on consumer advertising.”

It seems that Lechter is saying that the drug response was independent of the expectations of medication effectiveness, while the placebo response was driven be the prior expectations of the participants, as they were influenced by factors like direct-to-the-consumer advertisings. If true, this would seem to challenge, to a certain extent, the results noted above and in Kirsch’s previous research. Replication of the results is needed before Lechter’s conclusions from his research are accepted. It should be pointed out that paroxetine (Paxil) was approved by the FDA in May of 1996, while direct-to-the-consumer advertising of medications did not begin until 1997. Therefore, it would not have had an effect upon the paroxetine data reported above. I would also feel more comfortable with Lechter’s interpretations of his data if he didn’t have as extensive an association with the pharmaceutical industry. See the “Declaration of interest” in the linked abstract from The British Journal of Psychiatry.

 
03/16/15

Krypton Can Kill You

© Jason Yoder | 123RF

© Jason Yoder | 123RF

Krypton can kill you—even if you’re not Superman. And I’m not talking about the home planet of Superman. Krypton is a combination of powdered kratom and O-desmethyltramadol (O-DSMT), an active metabolite of Tramadol. Four researchers in Sweden published a case report in the Journal of Analytical Toxicology that investigated the deaths of nine individuals from their use of Krypton. One of alkaloids in kratom, mitragynine, is a mu-receptor agonist, as is O-DSMT. The mu-receptor is the primary receptor activated by opioid drugs such as morphine, hydrocodone (Vicodin), and oxycodone (OxyContin).

Combining these two mu-receptor agonists makes Krypton more powerful than kratom or Tramadol alone. Even pro-kratom websites are warning people about Krypton. O-DSMT is also reported to be considerably more potent as a mu-agonist than Tramadol. At the current time, both are legally available substitutes for prescription and illicit opioids.

Although kratom is currently not controlled under the Controlled Substances Act, it is on the DEA list of Drugs and Chemicals of Concern. And there is no current legitimate medical use for kratom in the U.S. So it cannot be legally advertised as a remedy for any medical condition. However, it is widely used for medicinal reasons, largely pain management issues and opiate withdrawal. Kratom is also reported to be a stimulant in small doses; a sedative and relaxant in larger doses; a mood and concentration enhancement; and others. Prozialeck et al. indicated there are more than 20 active compounds that have been isolated from kratom so far.

In Southeast Asia, kratom has a long history of use for pain management and opium withdrawal. As the West experiences an increased use of opioids for recreation and pain management, kratom has begun to be used in a similar way. Despite the kratom’s reputation as a “legal” opioid, there have been very few published scientific studies of its psychoactive properties and no well-controlled clinical studies of the effects of kratom on humans. However, there are several anecdotal reports available online, such as those on Erowid.

A variety of adverse effects from kratom use have been reported, consistent with its dose-related stimulant and opioid activities. Stimulant effects at lower doses can be anxiety, irritability, and increased aggression. Opioid-like effects at higher doses can include sedation, nausea, constipation and itching. Chronic high-dose usage has been associated with hyperpigmentation of the cheeks, tremors, anorexia, weight loss, and psychosis. There have been several reports of seizures.

Given that kratom is available as an herbal supplement, there is a lack of regulation and standardization related to the production and sale of kratom. Thus the problems with products like Krypton. Although it is typically seen as less addictive than classic opioids, there are many reports that it can be highly addictive. In Southeast Asia, individuals will seek out and abuse kratom for its euphoric and mind-altering effects. Chronic users can become tolerant of and physically dependent on kratom. Withdrawal symptoms are similar to those from traditional opioids.

Prozialeck et al. said that kratom and kratom-derived drugs could potentially be used for managing pain, opioid withdrawal symptoms and other clinical issues. Yet there remain serious questions about the potential toxic effects, as well as the abuse potential of kratom. The lack of quality control and standardization in the production and sale of kratom further complicates these questions.

In the meantime, remember that even pro-kratom websites are warning about Krypton. Kratom Online has put out a warning that a product called “Krypton Kratom” is being marketed and sold as a kratom product, when it is a blend of caffeine and O-DSMT.

Well, disingenuous marketers have tried to pull a fast one on the public by using the kratom name on a product that is not kratom. This blend of synthetic opiates is extremely strong and some say extremely toxic. In fact, taking just .5 grams of Krypton is said to be the equivalent of 60 grams of morphine. This is an extremely dangerous dose and could lead to severe health problems.

They cautioned buyers to be alert for anything marked as “Krypton Kratom” and called it “an instantly dangerously addictive substance.” We seem to be moving back to the days of free-wheeling patent medicines, when products like Krypton and even kratom can be legally sold, but not regulated to prevent their abuse potential.

03/13/15

Light in the Spiritual Darkness

© Noel Powell | 123RF.com

© Noel Powell | 123RF.com

In his commentary on Matthew, Craig Blomberg thought that no other religious discourse in history has attracted the attention devoted to the Sermon on the Mount. Both Christians and non-Christians alike have admired the teaching contained here. Leo Tolstoy believed the Sermon on the Mount was the true gospel of Christ and centered his book, The Kingdom of God is Within You on what it taught. Both Gandhi and Martin Luther King were influenced by Tolstoy’s teachings on nonviolence in that work. Gandhi reportedly said that when he read the Sermon on the Mount, it “went straight to my heart.” Dr. Bob, one of the cofounders of Alcoholics Anonymous (A.A.), said that the Sermon on the Mount was one of the “absolutely essential” passages of Scripture in the early days of A.A., before the Big Book was written. It is this last association that I want to explore here.

According to Sinclair Ferguson, the Sermon on the Mount is not about an ideal life in an ideal world. Rather, it is about “kingdom life in a fallen world.” In a similar way, the 12 Step recovery program is about sober life in a drinking world.  Whether you are trying to live out a kingdom life or a sober life, they both call for radical lifestyle changes within their respective worlds.

At times, there has been some cross-pollination between those two worlds. When Bill W. introduced Sam Shoemaker at the 20th anniversary convention for A.A., he said that “It is through Sam Shoemaker that most of A.A.’s spiritual principles have come.” In his talk, Shoemaker said he thought the great need of our time was for a vast, world-wide spiritual awakening. He believed that A.A. was one of the great signs of that spiritual awakening. He thought that A.A. had indirectly derived its “inspiration and impetus” from the insights and beliefs of the church. And he hoped the reverse would be true. “Perhaps the time has come for the church to be reawakened and revitalized by the insights and practices found in A.A.”

The Sermon on the Mount seems to be one of those places where A.A. was cross-pollinated with some of the insights from Scripture. Here are a few examples. In the Big Book, Alcoholics Anonymous, it says that resentment is a “number one” offender. “It destroys more alcoholics than anything else. From it stem all forms of spiritual disease.” Three separate sections of the Sermon on the Mount could be relevant. There is one on anger (5:21-26); one on retaliation (5:38-42); and one on loving your enemies (5:43-48). Oh, and one of the Beatitudes (5:7): “Blessed are the merciful, for they shall receive mercy.”

The A.A. website said there is nothing concrete to point to when or where the saying “one day at a time” became one of the slogans of A.A. It could have originated with the Oxford Group; or it could have been originated with Bill and Dr. Bob. In the A.A. book, Dr. Bob and the Good Oldtimers (p. 282), Dr. Bob is quoted as saying: “‘Easy Does It’ means you take it a day at a time.” A.A. historian Dick B. wrote that Anne Smith, Dr. Bob’s wife, mentioned “one day at a time” in her notebook. Both Anne, Dr. Bob and Bill W. were active with the Oxford Group in the 1930s. In his book, The Akron Genesis of Alcoholics Anonymous, Dick B. reported that one of Dr. Bob’s early sponsees, Clarence S. said Dr. Bob told him the concept for one day at a time came from Matthew 6:34.

The principle of anonymity, which is so important to A.A. (it’s even part of the program’s name, Alcoholics Anonymous), can be found here as well. The forms of piety (giving alms, prayer and fasting) that Jesus addressed in Matthew six are all tied together with anonymity. In his book Turning Point, Dick B. made the same point and even cited where Bill W. wrote on the importance of anonymity as he sought to convince A.A. to adopt what would become the Twelve Traditions. First appearing in the Grapevine in November of 1948, and then gathered into the A.A. published book, The Language of the Heart, Bill W. began his essay on Tradition Twelve:

One may say that anonymity is the spiritual base, the sure key to all the rest of our Traditions. It has come to stand for prudence and, most importantly, for self-effacement. . . . In it we see the cornerstone of our security as a movement; at a deeper spiritual level it points us to still greater self-renunciation.”

Matthew began the Sermon on the Mount simply. When Jesus saw the crowds following him, he went up onto a hill (or mountain) and sat down, signally to his disciples that he was getting ready to teach them. So they gathered round him (Matthew 5:1-2). The Greek word translated here as disciple meant someone who was learning through instruction; someone who was an apprentice. We might even suggest it could refer to a sponsee in 12 Step recovery.

There seems to be a careful, intentional structure to the Sermon on the Mount. There is a beginning (5:1-2) and ending (7:28-29) to frame his teaching. The Beatitudes (5:3-12) and the “salt and light” passage (5:13-16) serve as an introduction. Matthew 5:17-20 declares the righteousness required by those who would follow Jesus—they have to be more righteous than the most religious sect of his time, the Pharisees.

Then within a series of six antithetical teachings on anger, lust, divorce, oaths, retaliation, and loving your enemies, Jesus contrasts his teaching with “what they have heard” in Matthew 5:21-48. Beginning in chapter six, Jesus contrasted true and hypocritical piety (6:1-18). Next he turns to address social and personal issues regarding money (6:19-24), how we will live (6:25-34), and how we should treat others (7:1-12).

Jesus then ended his Sermon by urging his listeners to enter into life (7:13-14). The gate leading to destruction is wide and its way easy. But the gate leading to life is narrow and the way is hard. He cautions them to watch out for wolves in sheep’s clothing. You’ll know them by their fruits. Those who enter the narrow gate are those who do the will of the Father—and not necessarily those who did many works in His name. If you hear his words and do them, you will have a solid foundation.

On November 10, 1948, General Omar Bradley gave an address in celebration of Armistice Day. His words fit here as well as speaking to the timeliness of spending time reflecting on the Sermon on the Mount.

With the monstrous weapons man already has, humanity is in danger of being trapped in this world by its moral adolescents. Our knowledge of science has clearly outstripped our capacity to control it. We have many men of science; too few men of God. We have grasped the mystery of the atom and rejected the Sermon on the Mount. Man is stumbling blindly through a spiritual darkness while toying with the precarious secrets of life and death. The world has achieved brilliance without wisdom, power without conscience. Ours is a world of nuclear giants and ethical infants. We know more about war than we know about peace, more about killing than we know about living.

You can find a series of further articles that look at passages from the Sermon on the Mount under the category link by that name. This series is dedicated to the memory of Audrey Conn, whose questions reminded me of my intention in seminary to look at the various ways the Sermon on the Mount applies to Alcoholics Anonymous and recovery.

03/11/15

Lair, Liar Pants on Fire

© Wisconsinart | Dreamstime.com

© Wisconsinart | Dreamstime.com

Okay, well perhaps TECHNICALLY Janssen Pharmaceuticals, a division of Johnson and Johnson (J&J) didn’t lie about Risperdal to the public. But thousands of recent lawsuits have charged that there is a troubling side effect in young men who take the medication: gynecomastia. That means it can trigger abnormal breast growth in the males who use the drug.

Mad in America reported that the law firm of Pintas and Mullins (linked above) reported that there were 1,250 pending cases against  J&J (most of which are related to abnormal breast growth) out of which six were selected as “bellwether” trials in 2012. However, Janssen agreed to settle those cases before they went to trial. Janssen also agreed to settle another 80 cases in early 2013. Historically, this has been a regular legal tactic of pharmaceutical companies when they are sued. Peter Breggin has noted how this method and others were used by pharmaceutical companies to neutralize potentially damaging lawsuits against them; and keep the information they contained from becoming public knowledge.

But that doesn’t always work. Pintas and Mullins, Mad in America, Peter Breggin and FiercePharma have reported on past settlements made by Janssen for misleading statements about Risperdal.  In November of 2013 Janssen agreed to pay a $2.2 billion settlement with the federal government for false claims over Risperdal. The company pled guilty to illegally promoting the off-label use of Risperdal with the elderly suffering with dementia or Alzheimer’s in nursing homes. Janssen also settled off-label marketing claims with 36 states and the District of Columbia over Risperdal for $180 million; then with Texas for another $158 million. So I suppose we could say that Janssen was found guilty of lying about Risperdal in these off-label marketing cases.

Recent cases include a lawsuit argued in Philadelphia regarding a 20-year-old man with autism, who took Risperdal to help with irritability caused by his autism. He began taking the drug as an eight-year-old, despite the fact it was only approved for use with adults at that time. FiercePharma reported that the man’s then pediatric neurologist, Jan Mathisen, said sales reps from Janssen had distributed Risperdal samples twenty times between 2002 and 2004, 5 years before the drug was approved for use in autistic children. After a day in court, the autistic man’s mother tearfully said that she was having a difficult time after “Hearing what the pharmaceutical company was doing.”

Janssen claimed that the company’s warnings were complete and proper, and that it did not miss-market the drug. In a statement provided to Blooomberg Business, a Janssen spokesperson claimed that Risperdal “has improved the lives of countless children and adults throughout the world who suffer from debilitating mental illnesses, and it continues to improve patients’ quality of life today.”

Janssen claims that Risperdal’s labels always included warnings of the risk of gynecomastia in adults, and notified doctors that it was not proven safe for use in children. The Pintas and Mullins article said the company claims that the doctor who prescribed Risperdal to the autistic man should be held at fault. In addition,

Janssen is accused not only of illegally marketing Risperdal, but also of paying doctors to speak favorably of the drug. The company paid for gold outings and other flashy incentives to get doctors to prescribe the drug to patients just like the eight-year-old in Alabama. Many of those boys taking Risperdal grew breasts and had to undergo mastectomies.

A former FDA commissioner, David Kessler, testified in Philadelphia that Johnson and Johnson knew as early as 2001 that Risperdal could cause boys to grow breasts—a full five years before the company added the warning about the potential side effect to the drug’s official label. In support of his claim, Kessler pointed to a 2001 study, FUNDED BY J&J that indicated 3.8% of boys using Risperdal in a clinical trial developed breasts. He commented that the study should have been a red flag to the company. According to Bloomberg, the neurologist Mathisen said in his testimony that he would have liked to have known about the study.

A J&J lawyer said that Kessler was a biased witness or “hired gun” because he commonly testified in drug-safety trials since leaving the FDA in 1997 (see articles here and here). She suggested that he was “cutting and pasting” findings from other cases into his conclusions that: 1) officials at Janssen knew Risperdal caused some boys to develop breasts and 2) failed to alert patients, doctors and regulators about it. Kessler disputed her claims saying, “Each case is complex and there is an enormous amount of details associated with them . . . . To say I’ve testified each and every time the same way would be incorrect.” He also indicated where he has testified on behalf of pharmaceutical companies in the past.

As I first wrote this, the trial in Philadelphia was scheduled to take another few weeks. I was rooting for a ruling in favor of the autistic man and his family, which did happen! The Wall Street Journal reported that a Philadelphia jury decided Johnson & Johnson had to pay $2.5 million in damages for failing to warn that Risperdal could cause gynecomastia. The attorney representing the autistic man said: J&J “hid data from the FDA, prescribing doctors and parents. Documents showed they knew there was much higher percentage of children getting gynecomastia than they admitted.”

The settlement is relatively modest, considering what J&J has made from Risperdal. In the seven years between 2003 and 2010, Risperdal grossed more than $24 billion worldwide; 4.5 billion in 2007, the year it went off patent. While there should be enough capital to settle the case without J&J going bankrupt, with the additional 1,200 plus lawsuits, it may be a good time to divest yourself of J&J stock.

03/9/15

Warning All Bakehead Drivers

© Karen Roach | 123RF.com

© Karen Roach | 123RF.com

“Our society is changing our views on marijuana, it’s becoming legalized in many states… young people have no fear of driving after smoking.” (Kal Mahli)

As I write this article, 23 states and the District of Columbia have laws legalizing marijuana in some form. Four states (Colorado, Washington, Alaska and Oregon) plus the District of Columbia have legalized recreational marijuana, the rest have passed medical marijuana laws for limited use of cannabis. Here is a map showing which states have legalized marijuana for medical and recreational purposes.

There’s been a prediction that the 2016 election year could be a “break-out” year for several states legalizing recreational marijuana. Phillip Smith of AlterNet suggested that seven states are likely candidates for that to happen: California, Nevada, Arizona, Maine, Massachusetts, Vermont, and Missouri. This growing legalization movement is also spurring on the development of the pot breathalyzer.

A company called Cannabix Technologies has received some recent media attention on its cutting-edge drug-impairment recognition system: the Cannabix Marijuana Breathalyzer. It is a patent pending device that will detect if an individual has used THC in last two hours. The device is currently in prototype development, and the company said in a February 2 news release that it hopes the prototype will be complete “in the coming weeks.” You can watch a video promo of the product here on YouTube.

The President and Director of Cannabix is Kal Malhi, a former member of the Royal Canadian Mounted Police (RCMP). He worked in the marijuana enforcement division for four of his ten years with the RCMP. Dr. Raj Attariwala, a Vancouver radiologist and nuclear medicine physician, is the Lead Engineer of the company. Malhi got the idea for the Cannabix breathalyzer while doing some reading while on a family trip to India. At an airport, he read about a Swedish study that used breath testing technology developed at Kerolinska University. The Swedish study showed how breath samples could be collected and sent to a lab for testing.

Malhi said the device functions like a blood glucose meter. “The breath sample is collected in one component and then is fed into a second part of the device, which tests the sample and gives an immediate result.” He said it could also be used in workplaces to carry out drug testing on employees. Product development is moving along quickly. Johnny Plankton at AfterPartyChat noted that Market Watch suggested that Cannabix Technologies could warrant a closer look by investors. He indicated that Mahli hopes to launch the device by the end of 2015.

Cannabix isn’t the only one attempting to develop a THC breathalyzer. Lifeloc Technologies, a Colorado-based company making breathalyzers, has been awarded a $250,000 grant from the Colorado Office of Economic Development to develop one. The CEO of Lifeloc, Barry Knott said that the company was in a race with itself to develop their own pot breathalyzer. “As far as we know there’s nobody else as far along in this.” They hoped to have the prototype by late 2015. Hey Barry, you may be behind Kal and Cannabix.

Researchers at Washington State University are also developing a breathalyzer for marijuana. Herbert Hill, a chemistry professor, is working with a research team from the university to develop the device. He told the Tacoma News Tribute: “We believe, at least initially, that it would lower the false positives that an officer would have. . . . They would have a higher level of confidence in making an arrest.” Lawmakers have expressed public support for the research. Hill and his team should be finished with their protoype by now and plan to test the device on human breath in 2015. Looks like there is at least a three-way race here.

But Adam Banner, a criminal defense lawyer with experience defending DUI cases, said he felt the marijuana breathalyzer may do more harm than good. Among his biggest concerns was the “zero tolerance” policy for drugged driving in some states like Oklahoma. Banner said that in these states a person could be charged with a DUI for having any detectable amount of THC in their system. He noted that in Washington State (as in Colorado) the current limit for driving under the influence of THC was 5 nanograms of active THC per milliliter of blood (5ng/ml).

Consequently, a person could be criminally charged for driving under the influence days or even weeks after he or she used marijuana–long after he or she was under any influence of the drug and when his or her driving would likely be unimpaired by the past drug use.

Banner seems to be misdirecting attention to a problem that doesn’t exist when he says: “In fact, in many states, the marijuana breathalyzer would ultimately put unimpaired drivers in jail instead.” He acknowledged that: “Drivers with a THC concentration greater than 5 ng/mL–the amount determined for DUID in Washington–have a significantly higher accident rate than drivers with no THC in their systems.” But his rhetoric gave an example of the hypothetical arrest of an individual returning to a zero tolerance state from a Colorado pot vacation who gets pulled over for a burned out tail light-and ends up arrested for DUID (driving under the influence of drugs) because he failed the breathalyzer—“despite being in no way impaired.”

Banner seems to have not read the information that indicates the THC breathalyzers are testing for the recent use of THC, sometime within the past two hours. He is right that a pot breathalyzer would increase the number of DUI arrests. But it doesn’t suggest that those arrests will be drivers posing no greater risk than teetotalers who never indulge. If marijuana legalization makes THC more likely to be in the bloodstream of individuals who drive, then the technology to accurately detect THC levels and research into their effect of driving will be done. As Banner said in the beginning of his article, he is all for finding ways to accurately indentify and eradicate impaired driving.

Or as Johnny Plankton succinctly put it: “Bakehead drivers, don’t say you weren’t warned.”