03/29/16

Tip of the ADHD Iceberg

© bobbimac | stockfresh.com

© bobbimac | stockfresh.com

Stimulant medications prescribed to children with ADHD are known to cause hallucinations and psychotic symptoms. The risk of these adverse events was widely thought to be minimal, but a recent study published in the journal Pediatrics suggests that is not the case. MacKenzie et al. reported that psychotic symptoms were found in 62.5% of youth who had taken stimulants versus 27.4% of individuals who had never taken stimulants. The researchers said this association was still significant even after potential confounding variables were controlled.

Mad in America noted in “ADHD Drugs Linked to Psychotic Symptoms in Children” that clinical trials used to test the safety and efficacy of stimulant medications such as Adderall, Ritalin and Vyvanse estimate that only 1-2% of children on stimulants have such a reaction. MacKenzie et al. suggested these underestimates were partly because researchers often rely upon participants to self-report these symptoms, which leads to significant underreporting. Among the children diagnosed with ADHD in the study, 11 of 17 (65%) treated with stimulants experienced psychotic symptoms, while only 4 (25%) of the 16 who were not treated with stimulants had such symptoms.

The children included in the MacKenzie et al. study had at least one parent with a diagnosis of major depression, bipolar disorder or schizophrenia. However, “the association between stimulants and psychotic symptoms remained consistent after the researchers controlled for other risk factors, age, gender, and parent diagnosis.” The researchers were also able to confirm that the occurrence of the symptoms coincided with the time when the children were actively taking stimulant medications. They concluded:

We report an association between the use of stimulant medication and psychotic symptoms in children and adolescents at familial risk of mental illness. The association of current use of stimulants with current psychotic symptoms and the close temporal relationship between stimulant use and psychotic symptoms in youth who started and stopped stimulants indicated a potential causal relationship. The findings suggest that psychotic symptoms may be relatively common adverse effects of stimulants in youths with a family history of major psychiatric disorders.

In “Psychotic Symptoms in Children on Stimulants,” Dr. Lydia Furman, an Associate Editor for Pediatrics, said the study put a microscope on the subpopulation of children with an ADHD diagnosis, whose risk of psychotic symptoms is substantially higher. She added that the study was just the tip of the iceberg with regard to ADHD diagnosis, stimulant treatment and the risk in adulthood of psychotic disorders or episodes. She cited a study by Moran et al. that demonstrated how adult individuals with psychotic disorders, who were exposed to stimulants in their youth, had a significantly earlier age of onset of psychosis than those who were unexposed.

But Furman seems more interested in seeing ADHD diagnosis as an increased risk factor for adult diagnosis of psychotic disorders, rather than looking at the evidence of how stimulant medications seem to trigger or increase the risk of psychotic symptoms. She commented that an additional body of evidence suggests that ADHD diagnosis in childhood is associated with an increased risk of adult diagnosis of psychotic disorders, and then referenced two studies: Rho et al. and Dalsgaard et al. It wasn’t clear to me from the abstracts that stimulant medication as a confounding variable was controlled for in either study.

Given that the MacKenzie study found the symptoms of psychosis occurred during the active use of stimulant medication, and that the association remained even after the researchers controlled for risk factors including parental diagnosis, it seems the more significant results were that using stimulant medication may trigger hallucination and psychotic symptoms more frequently than has been previously reported.

Cherland and Fitzpatrick reported in a 1999 study, “Psychotic Side Effects of Psychostimulants,” that 6% of children developed psychotic side effects from methylphenidate (Ritalin). They also indicated their findings likely were an underestimate in the prevalence. Significantly, the symptoms stopped as son as the medication was discontinued. No psychotic symptoms were reported among children diagnosed with ADHD who did not receive medication.

Dr. Peter Breggin also reported the danger of ADHD medications triggering symptoms of psychosis in his article for International Journal of Risk & Safety in Medicine. He noted how several studies have compared stimulant-induced psychoses to the symptoms of schizophrenia. Methylphenidate has even been used to experimentally produce or worsen psychotic symptoms in adults diagnosed with schizophrenia. He commented that psychoactive drugs would tend to produce psychosis at a higher rate in children than in adults.

In his “Simple Truths About Psychiatry” series of videos on YouTube (Simple Truth 7 and Simple Truth 8), Dr. Breggin said stimulant drugs don’t fix or cure anything. They actually cause biochemical imbalances in the brain that make children docile, and take away their spontaneity. This adverse effect is then interpreted as a positive effect. I agree with Breggin that these drugs should never be given to children. Ultimately, he asserted that children who are raised on stimulant drugs will never know who they really are. “Since you’re messing up several neurotransmitters in the brain, you’re going to be causing life-long changes in the child’s brain.”

An NIH-funded study by Collins and Clearly found there has been a 43% overall increase in the diagnosis of ADHD since 2003. Among children between the ages of 10 and 14 the increase was 47%, and 52% among adolescents aged 15-17.  There were increasing trends for all racial/ethnic groups, most notably among Hispanics, where the increase in ADHD diagnosis was 83% from 2003 to 2011. Dr. Clearly hedged his bet, saying that the reported increase could be a true increase in ADHD or it could be the result of a tendency to over-diagnose the condition. “Additional studies must be done to identify the underlying cause of the increase.”

In the meantime, his advice was for parents to “talk to your doctor.” That is often pharma-speak for “get a prescription.” We may be just beginning to see the tip of the iceberg of consequences from ADHD medications.

03/25/16

A “God Moment” with DXM

© iofoto | 123rf.com

© iofoto | 123rf.com

One of the most coincidental encounters I’ve ever had in my experiences working with addicts and alcoholics involved someone intending to get high on DXM. One day when I was on my lunch break, I went to a local supermarket to get some hot food from their deli counter. When I was about fifty feet from the automatic doors, one of the individuals I knew from the treatment program exited the store and immediately made a left when he saw me. I called out a hello, which he answered as he just kept walking, saying he had just bought something to eat. Normally a friendly person, his behavior was unusual.

I wondered what could be going on as I went into the store. Then for some reason, I had the thought to go check the isle with the over-the-counter cold medications. The section was completely empty of cough suppressant capsules containing DXM, dextromethorphan. After I bought my lunch, I walked in the direction I has seen him hotfoot it away from me earlier and now saw him coming out of a sandwich shop. Hmm, I thought, he must be really hungry today.

I told him what I had found in the grocery store and then reminded him he had told me he bought something to eat there. Now he had some thing else from the sandwich shop. I also showed him a plastic bag with the grocery store’s logo that contained empty boxes of DXM cough suppressant. I told him that it had been on the top of a garbage can just outside the sandwich shop. He said he bought a drink in the grocery store before buying his sandwich and denied any knowledge of the empty DXM shelves in the grocery store. Of course he didn’t know how the empty DXM packets got there either. Then he left to meet the person giving him a ride home.

Back at the outpatient office, as I was telling the other staff members the above story, he walked in admitted that he had bought the DXM capsules. He said he hadn’t taken any and after I confronted him, he threw his baggy of capsules away. We talked of how close he had come to a lapse into active drug use and I encouraged him to not waste this pretty amazing intervention. We both agreed it seemed to be a “God moment” that put me in front of the store just as he was coming out. The last I heard, he was abstinent; but it took a few more tries at treatment before he got it.

Dextromethorphan (DXM) is a synthetic substance found in about 70 over-the-counter products mainly as a cough suppressant and expectorant. Other medical uses include the other symptoms from hayfever, colds, allergies and the flu: the temporary relief of sinus congestion, runny nose, cough, sneezing, itching of the nose and throat, and watery eyes. DXM was approved by the FDA in 1958 as a cough suppressant. As early as 1962, it was being used recreationally. Ironically it had been substituted for codeine in cough suppressant medications to cut down on abuse. When it became a popular recreational drug with “young heads,” DXM was temporarily removed from the OTC market in 1973.

By 1977 pharmaceutical companies reintroduced DXM cough syrup with an unpleasant taste when used in the large quantities necessary for a high. Within a short time those same manufacturers began to produce forms of DXM syrup with an “appealing flavoring.” Used as prescribed, DXM products do not lead to the altered states sought after by those who abuse it. Doses approximate 30 mg of DXM every four to six hours. A single recreational dose can range from 240 to 1500 mg. “Heavier users have been known to ingest up to 3 or 4 bottles a day.”

In high doses, DXM is a dissociative anesthetic with powerful psychedelic effects. Sometimes it is compared to PCP and ketamine, two other dissociative anesthetics. High dose DXM can lead to toxic psychosis and a host of other physiological and behavioral problems. See the link above and Medline Plus for further information and treatment for DXM overdose.

Dose dependent effects can vary from a mild stimulant effect with distorted visual perceptions to a sense of complete dissociation from your body. A bad DXM experience described on the pro-drug website Erowid said: “My DXM experience was even scarier than my shrooming experience when I thought that I’d lost my face and that I would never return from being completely and utterly confused.”

DXM abuse is largely done by teens looking for a cheap, accessible high. The guy I described above was in his early 20s. Katie McBride, writing for The Fix, described how one teenage boy named Nic had two nearly fatal DXM overdoses in “The Dangers of DXM.” She related information on the SAMHSA website from 2006 that reported an estimated 1 million people between the ages of 12 and 25 had abused OTC cough and cold medication in the previous year. I was not able to find more recent data on DXM or abuse of OTC cough and cold medication. Although there has been data gathered on nonprescription cold and cough medications, since 2006 it was not included in the annual National Surveys on Drug Use and Health (NSDUH).

Beginning in 2006 Monitoring the Future, an ongoing study of the behaviors, attitudes and values of American high school students, began tracking the use of DXM among 8th, 10th, and 12th grade students. Respondents were asked how often they used cough or cold medications to get high in the past year. All the surveyed grade levels reported decreased use from 2006 to 2014. The percentages in 2006 who had used DXM were as follows: 8th graders: 4.2%; 10th graders: 5.3%; 12th graders: 6.9%. By 2014, the percentages were: 8th graders: 2.0%; 10th graders: 3.7%; 12th graders: 4.1%.

The DXM Abuse Prevention Act of 2015 (H.R. 3250) has been introduced to amend the Federal Food, Drug and Cosmetic Act. H.R. 3250 would restrict the sale of DXM products to individuals under the age of 18, except with a valid prescription. Retailers would have to verify that they are not selling DXM to individuals under 18. It would also create a series of penalties for retailers violating the sales restrictions to under aged individuals. The FDA Law Blog reported:

In determining civil penalty amounts for violations, the bill would require consideration of whether the retailer “has taken appropriate steps to prevent subsequent violations,” including establishing a documented training program for all employees who sell dextromethorphan. The bill has received strong support by a number of anti-drug abuse, healthcare and industry organizations including the Consumer Healthcare Products Association, Drug Abuse Resistance Education (“D.A.R.E.”) and Partnership for Drug-Free Kids.”

According to the Monitoring the Future data, DXM use among teenagers has been decreasing. But we should keep in mind that 2% to 4.1% of high school students using DXM in the past year to get high is still a significant number. I’m not sure that H.R. 3250 will ever get out of committee and become law, but it has some good ideas, like restricting the sale of DXM products to individuals over 18, unless they have a prescription. The restrictions on pseudophedrine seem to work in keeping it out of the hands of wanna-be Walter Whites. Something similar should work with DXM products as well.

03/22/16

Nakedness in Genesis

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© adrenalina | stockfresh.com

Genesis 2:25 made the claim that Adam and Eve were both naked and not ashamed. However it is not trying to cast them as the first nudists. Nor is it suggesting that they were about to have sex for the first time. The sparseness of merely seeing a declaration of nudity doesn’t capture what is happening in this verse of Scripture. So let’s peek under the covers, so to speak, and see what this nakedness is all about.

The verse brings the curtain down on the scene in Genesis 2 where God makes a fitting helper for Adam from his side. Upon seeing the helper God made for him, the man (ʾādām) spoke for the first time in Scripture and said in Genesis 2:23. “This at last is bone of my bones and flesh of my flesh; she shall be called Woman (ʾiššâ), because she was taken out of Man (ʾîš).” Bruce Waltke pointed out in the Theological Wordbook of the Old Testament that while the Genesis narrator named Adam by his relationship to the ground (ʾădāmâ) in Genesis 2:7, Adam named himself in 2:23 in relation to his wife.

The word for “woman” here (ʾiššâ) is the most commonly used Hebrew word for woman and wife in the Old Testament. The Hebrew word for man (ʾîš) is typically used for an individual male in contrast to ʾādām for mankind. Frequently it is also rendered as husband (Genesis 3:6). While the use here of ʾîš andʾiššâ may be nothing more than a playful literary device, the surrounding context announced the beginning of a close and intimate relationship between the man and the woman.

It reflects God’s desire to provide man with a companion who would be his intellectual and physical counterpart. The permanency intended in the relationship is expressed in the assertion that man should leave his parents and cleave to his wife.

A close relationship between the man and the woman is also suggested in Adam saying: “This is at last bone of my bones and flesh of my flesh.” The phrase ‘flesh and bone’ is used figuratively to denote kinship (Genesis 29:14; Judges 9:2; 2 Samuel 19:12-13). It also can have a covenantal meaning, as in 2 Sam 5:1-3. Genesis 2:24 reinforced a covenantal meaning, when the narrator commented: “Therefore a man shall leave his father and his mother and hold fast to his wife, and they shall become one flesh.”

Leaving father and mother and clinging to one’s wife signifies the ending of one allegiance and the beginning of another. Victor Hamilton commented in his commentary on Genesis that: “Already Scripture has sounded the note that marriage is a covenant, rather than an ad-hoc, makeshift arrangement.” Paul clearly had this covenantal understanding in mind with his quotation of Genesis 2:24 in Ephesians 5, where he discussed marriage and how it represented the relationship between Christ and the church.

Frequently in Scripture the nudity indicated by the Hebrew tem for “naked” here, (ʿārôm), has a symbolic sense of exposure and even vulnerability. The explicitly noted lack of embarrassment of Adam and Eve also suggests their innocence. Isaiah walked naked (likely he wasn’t completely naked, but just without his upper garment) to signify Egyptian prisoners being led away by the Assyrians (Isaiah 20:2-4). The nakedness of the poor in Job 24:7 represents oppression. Nakedness in Hebrew thought was also associated with shame, as with the discovery of a drunken and naked Noah by his son Ham (Genesis 9:22-23).

A very similar term, ʿêrōm, is used ten times in the OT to designate spiritual and physical nakedness. In Genesis 3, it refers to Adam and Eve after their sin (Genesis 3:7, 10, 11). More than just an awareness of their physical nakedness, Adam and Eve are also aware of their guilt before God—they had lost their innocence.  Additionally, “Their relationship with God was impaired, upsetting their relationship to each other.” In Ezekiel 16:7, 22, 29; 23:29 and Deuteronomy 12:29, ʿêrōm is used of the personified Jerusalem, suggesting both her material and spiritual poverty. Used in Ezekiel 18:7, 16 it indicates the proper social concern of righteous in providing clothes for needy.

The word for naked (ʿārôm) in Genesis 2:25 also appears to be a subtle play on the word translated “crafty” in the following verse, Genesis 3:1: “Now the serpent was more crafty (ʿā∙rûm) than any other beast of the field that the LORD God had made.” So Genesis 2:25 contrasts the naked innocence and vulnerability of Adam and Eve to the craftiness of the serpent in Genesis 3:1. As a result of the serpent’s craftiness, Adam and Eve sinned. Ironically, their first bit of newfound wisdom was to realize that they were naked (ʿêrōm) before God (3:7, 10, 11).

The innocence and vulnerability of humanity was lost as a result of their decision to disobey God’s command. They disobeyed in part due to the craftiness of the serpent. He promised that they would be like God, knowing good from evil after they ate the forbidden fruit. They did become “like” God in knowing good from evil. And the first bit of knowledge they gained was realizing they were guilty before God for their disobedience. They were now naked (ʿêrōm) and ashamed, when they used to be naked (ʿārôm).

03/18/16

Smoke and Mirrors

© Ivan Mikhaylov | 123rf.com

© Ivan Mikhaylov | 123rf.com

In this commercial, a guy named Herb said he stopped smoking with the help of Chantix: “The urges weren’t like they used to be and that helped me quit.” In the advertisement, which lasted 81 seconds, there were about twenty seconds worth of dialogue on asking your doctor if Chantix is right for you, telling you that Herb quit smoking with the help of Chantix and support and Herb’s 4 to 6 second testimony quoted above. The remainder of the commercial was a review of the potential side effects, which included: behavior changes, hostility, agitation, depressed mood and suicidal thoughts while taking or after stopping Chantix. Now watch this Saturday Night Live skit that essentially reworks all the same warnings about Chantix.

Soon after its approval in 2006, patients and their doctors began reporting adverse events such as suicidal thinking, aggression, depression and agitation. The drug was given a black box warning by the FDA in 2009 and then updated it in 2011. Refer to the medication guide for Chantix for more information on the possible side effects. But that wasn’t the end of concerns with the drug. In December of 2012, Chantix was linked by the FDA to the risk of a higher rate of heart attacks. A month later, the CEO of Pfizer was kept from testifying in court about the safety profile of Chantix because a plaintiff agreed to a settlement with Pfizer. Then in March of 2013, Pfizer agreed to a $273 million settlement for about 80% of the pending Chantix lawsuits.  In July of 2013, Pfizer said: “The resolution of these cases reflects a desire by the company to focus on the needs of patients and prescribers, and return the conversation to how Chantix can help smokers quit.” For more details on this description of the FDA and Chantix, see the various Chantix articles on FiercePharma from which this information was gleaned.

Pfizer began to win a few battles about Chantix. In September of 2014, a judge would not allow sealed court records of thousands of Pfizer documents related to the settled lawsuits to be opened. Out of court settlements with plaintiffs in cases against drug companies is standard operating procedure if it seems the case could be lost in court because then the related documents could be released into the public record. A standard condition of these kinds of settlements seems to require that all the documents that would have become evidence in a trial sealed.

That same month, the FDA approved changes to the medication guide for Chantix, suggesting that the drug might not be at greater risk of psychiatric problems. Pfizer wanted the black box warning removed. Steve Romano of Pfizer said: “Based on all this new information, a boxed warning is not supported. . . . The bottom line is that the label needs to reflect the most current understanding of the product’s benefits and risks.” Their target was a looming October 2014 FDA advisory panel meeting, where the committee would look at Pfizer’s data from observational studies and a meta-analysis of controlled trials conducted after the original side effects were reported.

FDA reviewers of the Pfizer data pointed out limitations with Pfizer’s meta-analyses and concluded that the observational studies “provided evidence of insufficient quality” to rule out an increased risk of suicide, suicide attempt or psychiatric hospitalization. Recent adverse event reports to the FDA were also said to be consistent with the findings that led to the black boxed warning. They noted how “neuropsychiatric side effects disappeared when patients stopped using Chantix, and/or recurred when therapy resumed.” It suggested that removing a black boxed warning had “limited precedent,” and should await the results from a controlled trial to be released in 2015.

The FDA finally announced its ruling in March of 2015. Not only did it keep the black box warning, it added new cautionary advice about Chantix’s interactions with alcohol. Some patients have reported increased drunkenness, blackouts and unusual or aggressive behavior while drinking. Others have had seizures. In September of 2015 Pfizer released the results of its latest study, in yet another attempt to convince the FDA to revoke the black-box warning. This large-scale by Kotz et al. followed 150,000 smokers over 6 months and found that individuals who took Chantix (known as Champix in Europe) were no more likely to have a heart attack then study participants using nicotine replacement therapy or another drug (Zyban) to facilitate smoking cessation. The study also found they were not at a higher risk of depression or self-harm. Three of the study’s authors reported financial ties to Pfizer independent of the study here.

One of the study’s authors, Aziz Sheikh, said that it was “highly unlikely that (Chantix) has any significant adverse effects on cardiac and mental health.” He though the drug’s black box safety warning “may be unnecessarily limiting access to this effective smoking aid.” Emily Wasserman commented this was exactly the kind of assessment Pfizer was looking for with Chantix. In 2014, Chantix grossed $647 million in worldwide sales; $377 million of which was in the U.S.

What was tellingly silent in this study was no further information on the association of Chantix (varenicline) with violence and aggression. A 2010 study, “Prescription Drugs Associated with Reports of Violence Towards Others” found that acts of violence towards other are associated with a relatively small group of drugs. Varenicline (Chantix or Champix) and antidepressants “were the most strongly and consistently implicated drugs.” Dr. Glenmullen, one of the study’s authors, was also one of the experts who unsuccessfully attempted to have thousands of Pfizer documents related to litigation over Chantix’s potential to trigger depression, suicide and violence made public.  Makes me wonder what was in those documents.

On the RxISK website, you can review an article on Chantix and Violence with a sampling of six selected cases taken from the FDA database on adverse events.  One case involved a 24 year old woman who said she was completely out of control by the third day of taking Chantix. She work her boyfriend up in the middle of the night and started physically beating him. She had suicidal ideation, homicidal ideation and an attempted suicide. Another woman, 28 years old, had a fit of uncontrollable rage after consuming alcohol one evening. She had been taking Chantix for about two weeks. It resulted “in me beating my boyfriend, followed by an attempt to take my own life. An overnight stay in the ER followed.”

Looking like the misdirection practiced by an illusionist, the attention on why Chantix should have its black box warning removed focused on two of the more serious adverse effects—depression and heart attack, but ignored a third—violence and aggression. The potential for violence was also been buried within catch-all categories such as “neuropsychiatric events” or adverse effects on mental health. Indeed, the recent Kotz et al. study admitted that it did not measure neuropsychiatric symptoms that involved aggression. So when the authors said they found no evidence of increased risk of “neuropsychiatric adverse events in smokers using varenicline” we need to recognize that symptoms involving aggression were not measured. They wouldn’t find any evidence for something if they didn’t look for it.

Finally, Paul Christiansen reviewed a recent study published in JAMA that compared the effectiveness of Chantix (varenicline) to the nicotine patch and combination nicotine replacement therapy (C-NRT, a nicotine patch and lozenge). The researchers concluded there were no significant differences in rates of smoking abstinence. “The results raise questions about the relative effectiveness of intense smoking pharmacotherapies.” Christiansen wrote that while the trial suggested there was evidence that varenicline and C-NRT may help lessen craving and withdrawal, there were significant adverse events with varenicline and C-NRT when they were compared to NRT—treatment with a nicotine patch only.

03/15/16

Gone Wild

© jdwfoto | dreamstime.com

© jdwfoto | dreamstime.com

It surprised me not only to see that a synthetic marijuana bust occurred 30-minutes from where I live; but that it made both the local and national news. ABC News, The Fix, a small local paper called The Cranberry Eagle among others reported on the joint operation by the PA State Attorney General’s bureau of Narcotics Investigation and the state police Southwest Strike Force. About 360 pounds in total of synthetic marijuana with an estimated street value of $1.6 million was seized. Intriguingly, three of the four individuals arrested were senior citizens. Talk about putting away something for your retirement.

Two of the individuals owned and operated several tobacco and drug-paraphernalia shops in the tri state area of Pennsylvania, Ohio and West Virginia.  According to court records, they would receive shipments of synthetic marijuana from out-of-state suppliers at their Cranberry Township shop, where they would allegedly break down the packages for resale. They were both charged with multiple offenses, including dealing in unlawful proceeds, criminal conspiracy and possession with intent to deliver synthetic marijuana. They were released on $50,000 bail.

In October of 2013 investigators seized about 73 pounds of synthetic marijuana at the UPS facility in Jackson Township. A few days later they seized two additional packages containing another 109 pounds of the drug. Multiple packages had been shipped to the Cranberry Township shop between December 2012 and October 2013 from the same individual in Tampa Florida. The grand jury received testimony that the shop’s owners also imported 3,000 to 4,000 packets of synthetic marijuana from New York and Massachusetts suppliers between October 2013 and November 2014. Search warrants obtained in November of 2014 led to the discovery of another 148 pounds of synthetic marijuana.

The Cranberry shop is one of six retail stores within a company known as “Glass Gone Wow.” All six stores are in the tri state area of Ohio, Pennsylvania and West Virginia. They are all upscale head shops. The home page for “Glass Gone Wow” highlights areas for Elite Glass, Electronics and Wellness. Also look at the Glass Gone Wow facebook page. The Elite Glass products are from several glass and water pipes companies. Yes, you can technically smoke tobacco in them, but I don’t think that is what the vast majority of Glass Gone Wow customers put in their pipes.

When I was on their website, there wasn’t any content under the Electronics link, but it would be for products like e-cigarettes, e-juice flavors and vaporizers.  The Wellness Center sells CBD Hemp products, and ‘exotic’ herbs such as Kratom, Kava, Blue Lotus and Damiana. The herbs are all legal, but three of them—Kratom, Kava and Blue Lotus—have psychoactive properties. Kratom is used as an opium substitute. Kava and Blue Lotus will produce mild psychoactive effects alone and more intense effects if mixed with other drugs. Look up these substances on Erowid, if you want to confirm what I’ve said here. Erowid is a pro-drug website offering extensive information on the history, effects and dangers of various psychoactive plants and chemicals.

CBD or cannabidiol is one of the 85 or so cannabinoids found in cannabis. THC or tetrahydrocannabinol is the primary psychoactive cannabinoid in marijuana, while CBD has the greatest medical potential. See “Let’s Not Get Ahead of Ourselves,” or “Clearing Away the Medical Marijuana Smoke” for more on medical marijuana. But the CBD Hemp products may not have the therapeutic effects they claim. First, any CBD product cannot make a medicinal claim without FDA approval. So the products are sold as dietary supplements, which the FDA has limited control over.

In order to force a company to remove a dietary supplement from the market, the FDA has to complete scientific studies and undertake complex legal procedures to support its recommendation. Simply put, it is usually more trouble than it’s worth. So dietary supplements abound, with little or no reliable scientific evidence to support their claims. We are largely going back to the days of the bogus claims of snake oil salesmen when it comes to these “dietary supplements.”

For example, there is a company named GreenGardenGold that sells “CBD-Rich products.” Their “About Us” page said it is one of the first companies to market CBD rich edibles. The company says their products are infused with CBD obtained from reliable providers and are legally shipped in all 50 states. They direct the reader to Project CBD for more information on the “potential therapeutic use of CBD. ”  There is then a list of 51 “Potential Therapeutic Uses of Hemp.” In the small print at the bottom of the list is the following:

Green Garden Gold makes no claim as to the efficacy of our products of the use of CBD in treating or combating the symptoms of the above list of medical conditions. We encourage our customers to sample our products for taste and quality. If, as a result of improved health is experienced, then we are delighted for the added bonus our products have provided.

Writing for Forbes, on March 9, 2016, Debra Borchardt indicated that the FDA sent out a number of warning letters to companies that make and sell products containing CBD. A spokesman for the FDA said the companies receiving the warning letters were in part selected because of the flagrant claims made about their products. He said:

Many of these products are claiming in their marketing and promotional materials that they are intended for the use in the diagnosis, cure, mitigation, treatment or prevention of diseases, including, for example: cancer, various infections, psychiatric disorders, multiple sclerosis, arthritis and diabetes.

The companies were told in their letters that they had 15 days to notify the FDA about how they were going to take steps to correct their violations, which include products with little or no CBD in them. Borchardt wrote: “No consumer should be sold an expensive product that claims to have CBD, but then has none whatsoever. Consumers should also get truthful information on the products they buy, i.e. the labels need to be correct.”

Looking at the FDA announcement, it seems that products from “Cali Stores” tested by the FDA were found to have no CBD in them at all. Green Garden Gold was one of the companies who received a warning letter from the FDA. You can read a copy of the letter sent to them by the FDA here. The levels of CBD in the two products tested by the FDA indicated there had .096% and .079% CBD. The range of CBD within the tested products went from 0% to 35%. The Green Garden Gold products were on the lower end of that range. The FDA announcement said:

In February 2016, FDA issued eight warning letters to firms that market unapproved new drugs that allegedly contain cannabidiol (CBD). FDA had previously issued six such letters in February 2015. FDA has tested these products, and many were found to not contain the levels of CBD they claimed to contain. It is important to note that these products are not approved by FDA for the diagnosis, cure, mitigation, treatment, or prevention of any disease. Consumers should beware purchasing and using any such products.

In October of 2014, writing for High Times, Mike Adams wrote about the proliferation of “knockoff CBD treatments.” He noted how CBD has become “rock star” popular in the medical marijuana industry because it can treat a variety of medical conditions. But CBD is still illegal in most of the U.S. This has resulted in “an opportunity for some hemp businesses to market a variation of knockoff CBD treatments that they claim have the same healing power as popular strains such as Charlotte’s Web.” Adams then noted where Project CBD launched a “full-blown investigation” into the matter.

He went on to say these products were only technically similar and “do not provide the same health benefits as high-CBD cannabis strains.”  Martin Lee, the director of Project CBD, wrote in the introduction of the report: “We believe that industrial hemp is not an optimal source of CBD, but it can be a viable source of CBD if certain hemp cultivars are grown organically in good soil and safe extraction and refinement methods are employed.”

The report focused on three companies that were operated by the same controlling interest.  You can read a copy of the report here. On page 13 of the report is a quote from a press release of the Hemp Industries Association stating its position on CBD Extracts Misbranded and Marketed as “Hemp Oil”.

It is important for America farmers and processors of hemp to understand that most CBD in products mislabeled as ‘hemp oil’ is a co-product of large-scale hemp stalk and fiber processing facilities in Europe where the fiber is the primary material produced at a large scale. CBD is not a product or component of hemp seeds, and labeling to that effect is misleading and motivated by the desire to take advantage of the legal grey area under federal law. Hemp seed oil does not contain any significant quantity of CBD.

The Glass Gone Wow shops were apparently used as fronts to sell synthetic marijuana. At least that is what the grand jury indictment of their owner-operators implies. The shops legally sell water pipes and other paraphernalia commonly used in smoking marijuana. Although I don’t know if the vape pens sold at Glass Gone Wow can be used with hash oil or marijuana, there are e-cigarettes that can be modified to do so. See “E-Cigarettes and E-Joints.” It is also evident that the CBD Hemp Products sold there do not contain high-CBD from medical marijuana. According to High Times, Project CBD and the Hemp Industries Association, their hemp products will only have a serendipitous effect on your health, as was implied in the Green Garden Gold advertisement: “If, as a result improved health is experienced, then we are delighted for the added bonus.”

But there is one final piece of information to leave you with. All six of the Glass Gone Wow stores are located within 2 miles of a high school, middle school or elementary school. This seems to be more than just coincidental, when teenagers are prime consumers of the company’s products. The webpage “About Money” gave the following tip for finding the right location for a retail store: “You know who your customers are, so make sure you find a location where your customers live, work and shop.”

This location claim is easily verified. Go to the Glass Gone Wow location page. Use Google maps to get directions between each site location and local schools. Gateway High School is 1.7 miles from the Monroeville store. There is a middle school 1.5 miles from the Cranberry store. There is an elementary school and a park just across the street from the Robinson store. There was even some concern voiced about this by the Montour Elementary PTA. There is a school 1.9 miles from the South Side store. In Morgantown West Virginia, a school is .8 miles away; and in Boardman Ohio, a school is 1.6 miles away.

03/11/16

Able to Sin

© jorisvo | 123rf.com

© jorisvo | 123rf.com

In the second book of his space trilogy, Perelandra, C.S. Lewis described how the Eden-like world of Venus was defended against an invading satanic character who attempted to get its “Adam and Eve” to disobey the clear command they had been given. Sound familiar? It is an alternative history, if you will, of the story of the Fall in Genesis. It raised an important question to me: What would have happened if Adam and Eve had successfully withstood the temptation in the Garden? Would that have been the end of the assault against them?

The answer to that question has to begin with what Reformed theologians like Anthony Hoekema call an understanding of the image of God in its “full biblical content. ” In other words, we need to consider human nature in the context of creation, fall and redemption.

In the beginning, before the Fall, Adam and Eve were “able not to sin.” This original imaging meant that Adam and Eve functioned sinlessly and obediently 1) in worshipping and serving God; 2) in loving and serving each other; and 3) in ruling and caring for creation. Although they were sinless in their original state, Adam and Eve “were not yet fully developed image-bearers of God.” There was still the possibility of sin; they were also “able to sin.”

This original condition was the boundary or the edge of the image of God; it was provisional and temporary. Adam and Eve were created in the image of God, but they were not yet a finished product. Herman Bavinck said: “Adam . . . had the posse non peccare [able not to sin] but not yet the non posse peccare [not able to sin]. He still lived in the possibility of sin.” Adam could either “pass over into either a state of higher glory or into a fall into sin and death.”

Human beings created in the image of God are self-conscious, free, responsible, religious agents. They were made upright and holy, and would have continued as such if they had remained faithful to the demands upon them “by reason of God’s propriety in [them] and sovereignty over [them].” This state was one of “an intensified and concentrated probation.” According to John Murray, as long as they did not commit sin, they remained in possession of their original moral and religious status. If they had successfully withstood the time of probation, they would have left it behind forever.

This meant Adam and Eve were at the beginning of the road humanity was meant to travel, to use Herman Bavinck’s metaphor. Still ahead of them was both their Fall and Redemption in Christ. So we should understand the original state of human nature before the Fall as able to sin, able not to sin: posse peccare, posse non peccare. As a consequence of the Fall, we were not able not to sin: non posse non peccare.

Without the work of Christ, we would have remained in a state of total inability to avoid sin; eternally separated from God. But through the Redemptive work of Christ, we have the guaranteed gift of non posse peccare (not able to sin). Creation, Fall, Redemption. But our current state is one of “already, but not yet,” in that while Christ has already come with the promise and down payment of non posse peccare, He has not yet returned to fulfill that promise.

In a similar fashion, Augustine described the four states of a Christian’s life, beginning with that of non posse non peccare, not able not to sin. The first state is when he or she is sunk in the darkest depths of ignorance, living according to the flesh, and undisturbed by conscience or reason. The second state comes when knowledge of sin comes through the law. Since the Spirit of God has not yet begun its aid, humanity was thwarted in it efforts to live according to the law. And being overcome by sin, became its slave (2 Peter 2:19). The effect produced by the knowledge of the law is that now they have the additional guilt of willful transgression of God’s law.

The third state comes when the Spirit of God begins to work within a person. Although there is still the old nature of flesh that fights against them (for their disease is not completely cured), yet they live “the life of the just by faith,” and in righteousness as far as they do not yield to their lusts and desires, but conquer them by the love of holiness. The one who by steadfast piety advances in this course shall attain the peace that shall be perfected after this life is over—the repose of the spirit. And then they achieve the resurrection of the body. And this is the fourth state.  “Of these four different stages the first is before the law, the second is under the law, the third is under grace, and the fourth is in full and perfect peace.”

Drawing on a graphic representation of human nature from Richard Gaffin, we have the following:

GaffinHumanity before the Fall had the ability to sin or not sin. They were created in the image of God as self-conscious, free, responsible, religious agents even with regard to sin. After of the Fall they could not help but sin; it was now part of their nature.  Without the redemptive work of Christ, humans can “be all they can be,” but they cannot transcend their fallen nature.

Every intention of their heart is to do evil (Genesis 6:5). It seems to me that the consequence of death for disobeying God’s command was both a blessing and a curse. Without death from sin, humanity would have become devils—eternally existing as beings not able to not sin. But God’s plan was to send a Savior; someone who could save us from this body of sin and death: Jesus Christ (Romans 7:23-24). Through the finished work of Christ, we have the guarantee of the promised renewal of human nature when Christ comes again (Ephesians 1:13-14).

But what of our original questions? What if Adam and Eve had successfully withstood the temptation in the Garden? Would that have been the end of the assault against them?

Until they had received the gift of a new nature, one that was not able to sin, they would have continued to be vulnerable to temptation. And, I believe, continually assaulted. At some point, this probationary time for humanity would have ended with the coming of a Redeemer—someone who would save them from the ability to sin. Either way, God planned to save us from ourselves. So it would have been creation, ability to fall, redemption.

What would that redemption have looked like? We will never know in this state. Perhaps we will in the next. But what we do know is that we can trust God. In the alternative history of Pelandra, Lewis, speaking through the character of Ransom said:

 Whatever you do, He will make good of it. But not the good He had prepared for you if you had obeyed Him. That is lost for ever. The first King and first Mother of our world did the forbidden thing; and He brought good of it in the end. But what they did was not good; and what they lost we have not seen.

03/8/16

Chemical Straightjackets for Children

© Sangoiri | Dreamstime.com

© Sangoiri | Dreamstime.com

In a five-minute video, “Stop the Psych Drugging of Children—Now!, Dr. Peter Breggin made some alarming statements about the consequences of several decades of giving children psychiatric drugs. He said we have parents who believe their children are incorrigible. And we have children who grow up thinking they are defective and need psychiatric drugs. Many of the children who started out with a mere ADHD diagnosis when they were younger are growing up to be “career mental patients, taking multiple psychiatric drugs.” In an article he published in the journal Children & Society, Breggin reviewed in more detail many of the concerns he just touched on in his video. Here, I want to look at the growing problem of using antipsychotics with children.

Mad in America reported that a study published in JAMA Psychiatry indicated that the majority of children, adolescents and young adults who are prescribed antipsychotic medications have not been diagnosed with a mental disorder. “Most of the younger children (60.0%), older children (56.7%), adolescents (62.0%), and young adults (67.1%) treated with antipsychotics had no outpatient or inpatient claim that included a mental disorder diagnosis.” Among the children who do have a diagnosis for a mental disorder, many of them are being prescribed antipsychotics off label.

In other words, while antipsychotics are only approved to treat children diagnosed with schizophrenia and bipolar disorder, children with diagnoses like ADHD are being given these powerful drugs to “treat” their behavior problems. In addition, very few of the children receiving antipsychotics also receive psychotherapeutic care. Mark Olfson, the lead author of the study said:

Relatively few of these young people are receiving psychotherapy. We may need to put greater effort into increasing access to psychosocial interventions that can treat symptoms and behaviors that are currently being addressed with antipsychotic medications.

In the same issue of JAMA Psychiatry in which the Olfson et al. article was published, Drs. Carroll and Blader acknowledged in “Antipsychotic Use in Youth Without Psychosis” that the use of antipsychotic medications has been increasing since the mid-1990s. They added this pattern was most pronounced in the U.S. They affirmed evidence suggests that second-generation antipsychotic use was chiefly with children with aggression and behavioral problems, ADHD, and disruptive behavior disorders. “Although antipsychotics are clearly effective for aggressive behaviors … other interventions with lower adverse effect burdens, when implemented adequately, can avert the need for antipsychotic treatment.”

Reporting for the StarTribune, Gail Rosenblum noted that in 2014 20,000 prescriptions for antipsychotic medications were written for children 2 and younger. According to IMS Health, a healthcare data company, that was a 50% increase over the year before. Turn to the article to see a photo of a child playing with Lego-like blocks branded with “Risperdal” at a pediatrician’s office.

IMS found that at least 10,000 children, ages 2 and 3, were prescribed medications such as Adderall to treat attention deficit hyperactivity disorder (ADHD). The protocol falls outside of American Academy of Pediatrics guidelines. Children younger than age 2 received prescriptions for risperidone (commonly known as Risperdal), quetiapine (Seroquel) and the antidepressant Prozac.

In his Children & Society article, Dr. Breggin noted where the so-called second-generation antipsychotics cause the same adverse effects as the older antipsychotics. These adverse effects include: “lobotomy-like indifference and apathy, Parkinsonian symptoms, akathisia, dystonia, tardive dyskinesia, neuroleptic malignant syndrome, gynecomastia [enlarged breasts in men] and other sexual dysfunctions.” Tardive dyskinesia (TD), a movement disorder caused by antipsychotic drugs, is a major threat to children, according to Breggin. TD can effect any muscle functions that are wholly or partially under voluntary control. That includes the face, eyes, tongue, jaw, neck, back, abdomen, and more. Here are two videos of what TD looks like in a child. The first is a girl after she stopped taking her medications, presumably because of the TD. The second one is of another young girl trying to fall asleep.

Even ‘mild’ cases of eye blinking or grimacing can humiliate, stigmatize and isolate a child. More severe cases disable children with painful spasms in the neck and shoulders, abnormal posture and gait, or constant agitated body movements.

Additional concerns with the newer antipsychotics include a potential predisposition to heart disease and early death; weight gain and obesity; elevated blood sugar and diabetes; elevated blood lipids and atherosclerosis, and high blood pressure.

The New York Times published an article by Alan Schwartz, that looked at the growing practice of giving antipsychotics to children under the age of 2. His introductory case illustration was a boy who was first prescribed the antipsychotic Risperdal when he was 18 months of age. His mother indicated that she was never told of the potential risks to her son with Risperdal. “It was just ‘Take this, no big deal,’ like they were Tic Tacs,” said Genesis Rios. The prescribing doctor declined to be interviewed by the NYT.

Cases like that of Andrew Rios, in which children age 2 or younger are prescribed psychiatric medications to address alarmingly violent or withdrawn behavior, are rising rapidly, data shows. Many doctors worry that these drugs, designed for adults and only warily accepted for certain school-age youngsters, are being used to treat children still in cribs despite no published research into their effectiveness and potential health risks for children so young.

Schwartz reported that almost 20,000 prescriptions for antipsychotics such as risperidone (Risperdal) were written for children 2 years old and younger in 2014. This was a 50% jump from the year before. As a side note, prescriptions for the antidepressant fluoxetine (Prozac) rose 23 percent in one year for the same age group. A dozen experts in child psychiatry had never heard of children younger than 3 getting such medication and had difficulty explaining a reason for it. Dr. Martin Drell, a former president of the American Academy of Child and Adolescent Psychiatry said he was “hard pressed to figure out what the rationale would be.” Dr. Ed Tronick, a professor of developmental and brain sciences at the University of Massachusetts said:

I think you simply cannot make anything close to a diagnosis of these types of disorders in children of that age. . . . There’s this very narrow range of what people think the prototype child should look like. Deviations from that lead them to seek out interventions like these. I think it’s just nuts.

The American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry have not taken a stand for or against the practice. They have no guidelines or position statements on the use of antidepressant or antipsychotics with children younger than 3. One possible factor in their silence is there are no formal trials in infants and toddlers with these medications. Dr. Mary Gleason a pediatrician and child psychiatrist at Tulane University School of Medicine said children with ages measured in months have brains whose neurological development was occurring at too rapid of a rate—and in still unknown ways—to risk using medications that could profoundly influence that growth. “There are no studies … and I’m not pushing for them,” said Dr. Gleason.

In an article for Psychiatric Services, psychiatrists at Dartmouth expressed concern about the increasing numbers of children being prescribed antipsychotic medications. In an article summarizing the concerns of the authors, Mad in America quoted them as saying:

The crux of the issue is this: Children in the United States have increasingly been prescribed antipsychotic medications despite potentially serious short- and long-term side effects. . . . Yet other efficacious and safer interventions are available. . . . We should be concerned about overuse of antipsychotics for many reasons. Children are inherently vulnerable because their brains and bodies are still developing and may be permanently altered by powerful medications. . . . Their disruptive behaviors are often related to disruptive parenting and stressful environments, which deserve primary attention. Adults may be motivated by the desire to achieve short-term control of behavior rather than to enhance children’s long-term growth and development.

Daviss et al. recommended five changes to reduce the use of antipsychotics in children. First, there is a need for preventive care that addresses socioenvironmental problems. Second, mental health professionals need to become more aware of the dangers of using antipsychotics in children as well as the availability of evidence-based therapies and interventions. Third, clinical guidelines need to be developed along with steps to ensure compliance with those guidelines. Fourth, there should be shared decision making when treating children with these medications. “Clinicians, patients, and parents all need better information on antipsychotics and should all be involved in deciding on appropriate treatment methods.” And fifth, education programs regarding these concerns are needed to reach the agencies and counselors who take care of and support vulnerable children.

Dr. Gleason commented that people are trying to do the best they can with the tools available to them. “There’s a sense of desperation with families of children who are suffering, and the tool that most providers have is the prescription pad.” These children and families deserve better than a choice between trying to cope with the behaviors they see their child struggle with, and using a chemical straitjacket with the potential of long-term cognitive and physiological harm.

03/4/16

Managing Stress in Recovery

© marigranula | 123rf.com

© marigranula | 123rf.com

People in recovery are particularly vulnerable to stress. In Using Stress Management in Relapse Prevention Therapy (RPT), Terence Gorski pointed out that effective stress management was not only critical for avoiding a resumption of drinking or drugging in the first two weeks of abstinence, but it was also important for individuals in recovery “to learn how to recognize their stress levels and use immediate relaxation techniques to lower their stress.”  Regular, heavy use of alcohol and drugs will likely have toxic effects on the brain, and in turn will create symptoms that cause stress and interfere with effective stress management.

The role of stress sensitivity in addiction and relapse has received a well-deserved amount of attention in the professional literature. Another article here, “Stress Sensitivity in Addiction and Relapse,” looked at some of the findings of Mary Jeanne Kreek and George Koob on the topic. A third researcher who has done extensive research into stress and its influence on addiction is Rajita Sinha of the Yale School of Medicine. You can watch her lecture on: “Clinical Neurobiology of Stress and Addiction” on YouTube. You can also read a couple of her published articles, “New Findings on Biological Factors Predicting Addiction Relapse Vulnerability” and  “Chronic Stress, Drug Use, and Vulnerability to Addiction.”

In her “New Findings” article, Sinha presented data that demonstrated high drug cravings are related to both stress and drug cues in addicted individuals when they are compared to social drinkers. The research findings indicate: “that alterations in physiological stress responses are associated with high levels of stress-induced and cue-induced craving and distress states.” These alterations were marked by increased emotional stress, heightened craving in abstinent addicted individuals compared to social drinkers. Refer to Figure 2 in the article for a chart comparing the findings. Sinha also noted a series of stressors that are associated with addiction vulnerability—the risk of developing an addiction and the risk of relapse. Table 1 in her article summarizes the types of life events chronic stressors, etc. associated with addiction risk.

The types of adverse events significantly associated with addiction vulnerability were parental divorce or conflict, abandonment, forced to live apart from parents, loss of child by death or removal, unfaithfulness of significant other, loss of home to natural disaster, death of a close one, emotional abuse or neglect, sexual abuse, rape, physical abuse by parent, caretaker, family member, spouse, or significant other, victim of gun shooting or other violent acts, and observing violent victimization. These represent highly stressful and emotionally distressing events, which are typically uncontrollable and unpredictable in nature.

An early recovery issue common to both alcoholics and addicts is Post Acute Withdrawal (PAW). Gorski described PAW as “a bio-psychosocial syndrome that results from the combination of brain dysfunction caused by alcohol and drug use and the stress of coping with life without drugs or alcohol.” PAW disrupts the person’s ability to think clearly, to manage feelings and emotions, as well as to manage stress and self-regulate behavior.

Stress negatively effects brain function in early recovery. As the level of stress goes up, the severity of PAW symptoms increase. And as PAW symptoms get worse, individuals in recovery begin to lose their ability to effectively manage stress. The result is that they are in regular, constant states of high stress that bounces them back-and-forth between emotional numbness and emotional overreaction. High stress then becomes linked with cravings because during active drug use, the addict or alcoholic self-medicates with alcohol or drugs. “So one of the first steps in managing craving is to learn how to relax and lower stress without using alcohol or other drugs.”

The severity of PAW depends upon the severity of brain dysfunction caused by addiction and the amount of stress experienced in recovery. It’s not practical to remove yourself from all stressful situations,  so you need to develop ways to handle stress when it occurs. “It is not the situation that causes stress; it is your reaction to the situation.” Gorski then proceeds to describe a simple tool to monitor stress called the Stress Thermometer. Then he described an immediate relaxation technique called Relaxed Breathing to help you noticeably lower your stress in two or three minutes.

In his Relapse Prevention Therapy Workbook, Gorski said the goal is to keep your stress level in the functional range of the Stress Thermometer, between 4 and 6. If your stress drops below a 4, your mind will wander and you won’t be able to stay focused. If your stress level gets to above 6, you will begin to lose focus; then become driven and defensive. “The higher your stress level goes the more problems you will experience.” If your stress level reaches 9 or higher, you may start to use automatic survival defenses such as fight (getting angry, belligerent, or violent), flight (mentally checking out or leaving; not returning), or freezing (becoming compliant; becoming immobilized in whatever situation you find yourself).

Look at his article linked above for a detailed description of the Stress Thermometer. You can also find a graphic rendition of it in another one of his articles, “Stress Self-Monitoring and Relapse.” Gorski commented that when measuring your personal stress, you’ll notice that it is a combination of three things: the intensity of the stressor, your ability to cope with or handle the stressor and your level of awareness while you are experiencing the stress. He added that it was possible to score yourself very low on the stress thermometer even when your stress is quite high.

This happens because you are distracted and involved in something else, like managing the crisis causing your stress. Or because your stress is so high, you are emotionally numb and don’t realize what you are feeling. Another possibility is that you have lived with such high stress for such a long time that you consider it normal. A final possibility is that you have trained yourself to ignore your stress.

The first step in learning to manage your stress is to learn how to recognize and evaluate your stress level through body awareness. Then you learn how to quickly get back to a low stress level by using the Relaxed Breathing Technique. Again, turn to Terry’s description monitoring your stress through body awareness and reducing your stress through Relaxed Breathing in the above linked article.

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.

03/1/16

The Antidote for Temptation

© kikkerdirk | stockfresh.com

© kikkerdirk | stockfresh.com

In Of Temptation, John Owen’s last direction on how to guard against temptation contains the ultimate antidote against the poison of temptation. Owen said this antidote was one that Christ himself gave preeminence in his address to the church of Philadelphia in Revelation 3:10. Since Christ is the same yesterday, today and forever, then his encouragement to the church in Philadelphia is for us today as well. This enables us to place the burden of resisting temptation upon “him who is able to bear it.” Therefore Owen thought it requires our particular attention.

In Revelation 3:10, Jesus said: “Because you have kept my word about patient endurance, I will keep you from the hour of trial that is coming on the whole world, to try those who dwell on the earth.” The Greek word used here for “patient endurance” refers to the state of expectation or patient anticipation of the arrival of someone or something. Coupled with the sense of “observed” for kept, then Jesus is saying something like, “Because you listened to what I said about waiting patiently, I will keep you from the time of temptation that is coming.”  First Owen unpacks what it means to “patiently endure;” and then how this perseverance is a means of preserving and establishing us in the faith of Christ’s promise.

This command to patiently endure is the work of the gospel. It means that our call to forbearance is based upon the patience and long-suffering that Christ exercises towards all persons—towards the saints; towards those of His elect not yet effectually called; and towards those of the perishing world. Owen said the individual acquainted with the gospel knows there is no more glorious then his patience.

That he should bear with so many unkindnesses, so many causeless breaches, so many neglects of his love, so many affronts done to his grace, so many violations of engagements as he doth, it manifests his gospel to be not only the word of his grace but also of his patience.

With regard to the elect who are not yet effectually called, “he stands waiting at the door of their hearts and knocks for an entrance” (Revelation 3:20). Often, for a long time he is scorned, persecuted and reviled by them. Yet while he stands at the door, his heart is full of love for their poor rebellious souls. He waits patiently, until “my head is wet with dew, my locks with the drops of the night” (Song of Songs, 5:2).

To the perishing world, He “has endured with much patience vessels of wrath” (Romans 9:22). While the gospel is preached, Christ endures many harsh words from them. But he lets them pass. He doesn’t strike back. Rather, he does what is good for them. “Nor will he cut this way of proceeding short until the gospel shall be preached no more. Patience must accompany the gospel.”

Implied in keeping this word are three things that will help keep us from the “hour of temptation”: knowledge, valuation and obedience.

The person that would keep this word must know it—be acquainted with it—in a fourfold way. First, they must know it as a word of grace and mercy, able to save them (Roman 1:16; Titus 2:11; James 1:21). “When the word of the gospel is known as a word of mercy, grace, and pardon, as the sole evidence for life, as the conveyance of an eternal inheritance; when the soul finds it such to itself, it will strive to keep it.”

Second, they must know it as a word of holiness and purity, to sanctify them (John 15:3; 1 Peter 1:2; 2 Timothy 2:19). The person who doesn’t know the word of Christ’s patience as a sanctifying, cleansing word and the power of it in their own soul, neither know it or keeps it. “The empty profession of our days knows not one step towards this duty; and thence it is that the most are so overborne under the power of temptations.” They are full of self, of the world, of fury, ambition, and almost all unclean lusts. Yet they yet talk of keeping the word of Christ!

Third, they must know it as a word of liberty and power to set them free. This freedom is not only from the guilt of sin and from wrath, for that it does as a word of peace and mercy. It is not only from the power of sin, for that it does as a word of holiness.  Rather, it is freedom from all outward respects of the world that might entangle them or enslave them. It declares us to be “Christ’s freemen,” in bondage to no one (John 8:32; 1 Corinthians 7:23).

There is nothing more unworthy of the gospel than a mind in bondage to persons or things, prostituting itself to the lusts of men or affrightments of the world. And he that thus knows the word of Christ’s patience, really and in power, is even thereby freed from innumerable, from unspeakable temptations.

Fourth, they must know it as a word of consolation, to support them in every condition.  “It gives support, relief, refreshment, satisfaction, peace, consolation, joy, boasting, glory, in every condition.”

The second thing implied in keeping this word is seeing its value: “It is to be kept as a treasure.” To value it as your chief treasure means that you “keep the word of Christ’s patience.” The person who wants to have consideration from Christ in a time of temptation must not disregard the things Christ sees as important.

This leads to the third thing in keeping this word: obedience. Personal obedience of all the commands of Christ is keeping his word (John 14:15). It is the life and soul of the duty required. We have arrived then at the apex of this safeguarding duty.

The person who is acquainted with the gospel in its excellencies—its mercy, holiness, liberty and consolation—makes it their business to surrender themselves to it. Then when opposition and apostasy tries the patience of Christ to the utmost, they will be preserved from the hour of temptation. This encompasses all of what has been said before; and it is the only way to guard against temptation. Let no one think they can be kept even one hour from entering into temptation without it. Wherever they fail to surrender to the gospel, temptation asserts itself.

The same promise of preservation given to the church in Philadelphia was given to the sealed servants of God in Revelation 7:3. We should remember that in every such promise there are three things: the faithfulness of the Father, who gives it; the grace of the Son, which is the promise; and the power and efficacy of the Holy Ghost, which accomplishes the promise.  The faithfulness of God consists in his discharge of his promises, for he will not reverse himself. As Paul said in 2 Timothy 2:13: “If we are faithless, he remains faithful— for he cannot deny himself.”

The grace of the Son is in every promise of the covenant, so that when the hour of temptation comes, the soul that has a right to the promise shall enjoy it. The Spirit is called “the Spirit of promise” not only because he is promised by Christ, but also because he effectually makes good the promise. “He also, then is engaged to preserve the soul walking according to the rule laid down.”

This constant, universal keeping of Christ’s word of patience will keep the heart and soul in such a frame, as wherein no prevalent temptation, by virtue of any advantages whatever, can seize upon it, so as totally to prevail against it. So David prays, Ps. 25:21, “Let integrity and uprightness preserve me.” This integrity and uprightness is the Old Testament-keeping the word of Christ,—universal close walking with God. Now, how can they preserve a man? Why, by keeping his heart in such a frame, so defended on every side that no evil can approach or take hold on him. Fail a man in his integrity, he hath an open place for temptation to enter, Isa. 57:21. To keep the word of Christ is to do it universally, as hath been showed.

Owen has more to say in elaborating on the promise of Christ to keep us from the hour of trial that is coming on the whole world (Revelation 3:10). But we will stop here. If you want to read his original work, here is a link to Overcoming Sin and Temptation, a trilogy of three by Owen: “Of the Mortification of Sin in Believers;” “Of Temptation;” and “Indwelling Sin.”