11/5/19

Ticking Time Bomb of Speedballing

What do the following celebrities have in common: John Belushi, Chris Farley, Phillip Seymour Hoffman, and River Phoenix? Their deaths were attributed to speedball use, a combination of cocaine and heroin or morphine. Speedballs may also combine other pharmaceutical opioids, benzodiazepines or barbiturates along with stimulants, as it seems was the case with the death of Phillip Seymour Hoffman. The combination of stimulant and depressant drugs suppresses the usual negative side effects of each class of drugs, which can lead to misjudging the tolerance or intake of one or both drugs. “Due to the countering effect of the cocaine, a fatally high opioid dose can be unwittingly administered without immediate incapacitation, thus providing a false sense of tolerance until it is too late.”

Combining stimulants and opiates dates back at least to Sigmund Freud, who unsuccessfully attempted to counteract a friend’s morphine addiction with cocaine. Freud later acknowledged he may have hastened his friend’s death by “trying to cast out the devil with Beelzebub.” Nevertheless, Freud continued his personal use of cocaine despite his failed attempt to counter his friend’s morphine addiction. Several scholars have debated whether or not Freud’s use of cocaine influenced his developing theories, especially their emphasis on sex. For more information on Freud and his cocaine use, see “Sigmund Freud was a Cocaine Evangelist and Addict.”

The polysubstance misuse of stimulants and opioids has not received much media attention, but in the evolving nature of the opioid crisis that may be changing. The CDC recently published the results of an investigation of drug overdose deaths with cocaine and psychostimulants in the US between 2003 and 2017. In 2017 there were 70,237 drug overdose deaths, of which nearly a third (32.9%) involved cocaine, psychostimulants or both. Nearly three quarters of cocaine-involved deaths and about one half of the psychostimulant-involved deaths involved at least one opioid. Between 2006 and 2012 there was a decrease in overall cocaine-involved death rates that seems to have paralleled a decline in cocaine supply, but they began to increase again in 2012 (See the following figures).

Drug overdoses continue to evolve along with emerging threats, changes in the drug supply, mixing of substances with or without the user’s knowledge, and polysubstance use. In addition, the availability of psychostimulants, particularly methamphetamine, appears to be increasing across most regions. In 2017, among drug products obtained by law enforcement that were submitted for laboratory testing, methamphetamine and cocaine were the most and third most frequently identified drugs, respectively. Previous studies also found that heroin and synthetic opioids (e.g., illicitly-manufactured fentanyl) have contributed to increases in stimulant-involved deaths. Current findings further support that increases in stimulant-involved deaths are part of a growing polysubstance landscape. Although synthetic opioids appear to be driving much of the increase in cocaine-involved deaths, increases in psychostimulant-involved deaths have occurred largely without opioid co-involvement; however, recent data suggest increasing synthetic opioid involvement in these deaths.

Among the 70,237 overdose deaths in 2017, 13,942 (19.8%) involved cocaine and 10,333(14.7%) involved psychostimulants. Death rates increased from 2016 to 2017 in both drug categories across demographic categories such as sex and race. Male overdoses involving cocaine increased 31.9%. Male overdoses involving psychostimulants increased 32.4%. Female overdoses involving cocaine increased 38.9%. Female overdoses involving psychostimulants increased 35.7%.

White, non-Hispanic overdoses involving cocaine increased 35.3%. White, non-Hispanic overdoses involving psychostimulants increased 40.0%. Black, non-Hispanic overdoses involving cocaine increased 36.1%. Black, non-Hispanic overdoses involving psychostimulants increased 33.3%. Hispanic overdoses involving cocaine increased 25.0%. Hispanic overdoses involving psychostimulants increased 33.3%.

Preliminary data for 2018 suggests continuing increases in drug overdose deaths. Given the rise in deaths involving cocaine and psychostimulants “and the continuing evolution of the drug landscape,” the authors called for a rapid, multifaceted and broad approach that included both surveillance efforts and prevention and response strategies. The mixture of opioids in stimulant-involved overdoses underscored the importance of continued opioid overdose surveillance and prevention measures, including the expansion of naloxone availability. The CDC is expanding its drug overdose surveillance to include stimulants. And it is implementing evidence-based opioid prevention efforts such as improving the ability for users to access care and collaborations with public health and public safety organizations.

The increase of stimulant deaths without opioid involvement requires efforts to identify and improve access to care for persons who only use stimulants as well. The authors also suggested implementing upstream prevention efforts focusing on shared risk with both opioids and cocaine. The Fix cited comments by Hans Brieter, a psychiatry professor at Northwestern University, on how cocaine is thought of as a safer drug to use by many people today. “There’s been a lot of bad press about other drugs.” Younger people today didn’t see firsthand the 1970s dangers of cocaine, he said, so they mistakenly believe it to be the safer drug. Increased efforts towards protective factors that address substance use/misuse and improve risk reduction (“don’t use alone”) should be made as well.

The concluding sentence of the CDC Report called for collaboration between the community and public health and safety organizations, in order to understand the local drug scene and reduce its risks to users of both drugs. “Continued collaborations among public health, public safety, and community partners are critical to understanding the local illicit drug supply and reducing risk as well as linking persons to medication-assisted treatment [MAT] and risk-reduction services.” Here we may be seeing a peek under the hood at what the authors fear the most with their suggested linking to MAT, namely the increasing synthetic opioid involvement in cocaine-involved or psychostimulant overdose deaths. Remember that speedballing mixes a stimulant with a depressant. Due to the offsetting effects of the two drugs, a fatal amount of an opioid could be used without a realization of the danger until it’s too late.

11/23/15

Cocaine’s Secret Ingredient

Writing for Time back in 2010, Maia Szalavitz described how the connection between levamisole and cocaine first came to light. In the summer of 2008, a man and a woman in their twenties were both admitted to a Canadian hospital with fevers, flu-like symptoms and dangerously low white blood cell counts. Although the symptoms were consistent with agranulocytosis, at the time it was only known as rare disease found in chemotherapy patients and others taking certain antipsychotic medications. Neither of the Canadian patients fit that profile. But they had one thing in common: they used cocaine. A search of the medical literature at the time didn’t find any studies linking agranulocytosis with cocaine.

But in April of 2008, a New Mexico lab had notified the New Mexico Department of Health (NMDOH) of a cluster of unexplained agranulocytosis cases in the preceding two months. The NMDOH launched their own investigation and “identified cocaine use as a common exposure in 11 cases of otherwise unexplained agranulocytosis.” In November of 2008, the NMDOH investigation and the Canadian public health officials connected with one another. In January of 2009 the NMDOH posted a notification of its findings on the CDC’s Epidemic Information Exchange. In a still separate investigation, public health officials in Seattle Washington identified 10 cases of agranulocytosis among persons with a history of cocaine use between April and November of 2009.

In the midst of this growing public health mystery, two high profile overdose deaths occurred. Celebrity disk jockey Adam Goldstein, better known as DJ AM, died of an overdose of cocaine and prescription drugs in September of 2009. Among the drugs found in his system was levamisole. Goldstein had been a fixture on the A-list party circuit and was a well-known cocaine user. Ted Koppel’s son Andrew accidentally overdosed in June of 2010. The medical examiner found a combination of drugs in his system at the time of death, including cocaine and levamisole. It was likely that neither men knew they had been snoorting any levamisole.

SAMHSA, the Substance Abuse and Mental Health Administration, posted a public health alert the same month of Adam’s death warning of the dangers of levamisole. Citing information from the DEA, the report said the percentage of cocaine specimens containing levamisole tested in its labs has steadily risen since 2002. In July of 2009, 70% of the illicit cocaine tested contained levamisole. They said there had been around 20 cases agranulocytosis, including two deaths associated with cocaine adulterated with levamisole.

Levamisole is used in veterinary medicine as a deworming agent for cattle, sheep and pigs. In the past, it was approved for use with humans to treat autoimmune diseases and cancer. It’s been increasingly found as an additive to cocaine in samples tested worldwide. It has some serious side effects like a weakened immune system, painful sores and wounds that don’t heal—the above noted condition called agranulocytosis. Left untreated, it could lead to death. Here is a short video on Adam’s death and some pictures of individuals with agranulocytosis from cocaine use. Don’t watch it if you have a weak stomach.

A recent case report in the British Medical Journal described a 42 year-old woman who came to an outpatient clinic in Britain suffering from vasculitis, an inflammation of the blood vessels. She had severe joint pain, muscle pain, intermittent abdominal pain and lesions. Initially, she repeatedly denied any cocaine use, but eventually admitted using it in the past. Hair testing done was positive for her recent use of levamisole-contaminated cocaine.

Erowid, a pro-drug website cautioned its readers to be honest with healthcare providers about their illicit substance use when they seek treatment for conditions like high fever that could be from levamisole to improve their chances of proper diagnosis and quick recovery. In other words, don’t do what the woman in the BMJ case report did. There was an informative article there on levamisole that noted how widespread levamisole-tainted cocaine is: Australia, Canada, Colombia, France, Guyana, Italy, Jamaica, the Netherlands, Spain, Switzerland, the United Kingdom, and the United States. Speculating why cocaine is adulterated with levamisole, Erowid said:

According to the DEA, levamisole–as well as other adulterants–is apparently present in some shipments of cocaine intercepted before they are broken up for further distribution to consumers. Considering that, in one batch, only 6% by weight of the total product sold as cocaine was levamisole, it seems possible it is more than simply a bulking agent. One theory is that levamisole or other adulterants boost the effects of cocaine, permitting material to pass for higher-quality product despite additional cuts made down the line. Another theory is that levamisole or other adulterants are added as chemical signatures used to track distribution of material.It may be that levamisole has been used because it has similar solubility properties to cocaine and therefore is difficult to remove and has not previously been considered a serious health hazard. As of October 1, 2009, there is no definitive answer as to why it is used as a cocaine adulterant.

Kim Gosmer, a chemist specializing in narcotic samples at the Department of Forensic Medicine as Aarhus University in Denmark speculated that levamisole-tainted cocaine originated from South America. Cited in a Vice article, he said that forensic chemists are finding levamisole-tainted cocaine all over world, increasingly from every level of distribution. Gosmer believed this suggested the adulterant is added to the cocaine in South America before it is exported. “So the question is: Why bother diluting high-grade cocaine that costs almost nothing to produce (compared to street prices) with a compound that’s more expensive than other adulterants and diluents?”

He went on to say that the amount of levamisole found in cocaine is typically not very large. So it’s not added strictly to cut the cocaine. But one of its metabolites called aminorex has amphetamine-like properties. Another possibility is that levasimole increases the amount of dopamine released by glutamate levels in the brain. “Levasimole could potentially increase the effect of cocaine through its release of dopamine.”

Casual cocaine users purportedly don’t have to worry; but habitual users should worry. With upwards of 70% of the cocaine from around the world testing positive for levamisole, the typical cocaine user will snort some levamisole sooner or later. SAMHSA warned levamisole was a dangerous substance and that agranulocytosis was a very serious illness that needed to be treated at a hospital. Remember the similar warning given by Erowid. So if you use cocaine, watch out for:

high fever, chills, or weakness
swollen glands
painful sores (mouth, anal)
any infection that won’t go away or gets worse very fast, including sore throat or mouth sores -skin infections, abscesses -thrush (white coating of the mouth, tongue, or throat) -pneumonia (fever, cough, shortness of breath).”

It used to be that you could trust drug dealers to only cut their cocaine and heroin with inert ingredients. It seems that the cost of snorting cocaine is going up in more ways than one.

07/13/15

Getting High is an Global Problem

Package with a drug against the passports and U.S. dollars — © blinow61 | stockfresh.com

Looking at information gleaned from the 2014 World Drug Report suggests two drug trends to expect over the next few years. A bumper crop of opium poppies globally (particularly in Afghanistan), points to an increased worldwide problem with heroin. Afghanistan grew about 80% of the world’s opium poppies in 2013. Second, the development of new psychoactive substances (NPS) has accelerated and doesn’t appear to be slowing down anytime soon. By December of 2013, there were 348 known NPS, an increase of 200% since 2009. There are now more NPS than the number of substances under international control (234).

Globally, an estimated 243 million people aged 15-64 used an illicit drug in 2012. The three primary groups of illicit drugs were: cannabis, opioids, and cocaine or amphetamine-type stimulants (ATS). Generally, men are two to three times more likely than women to have used an illicit substance. While there are regional trends to consider, overall global drug use seems to be stable. The extent of problem drug use, determined by the number of regular drug users and those with drug use disorders, was also stable globally, at around 27 million people. The estimated number of global drug users by drug type is in the table below.

Global Drug Use by Drug Type

	Cannabis	Amphetamine-like stimulants	Cocaine	Opiates (heroin, opium)	Opioids (opiates and synthetics)
	Cannabis	Amphetamines	Ecstasy	Opiates (heroin, opium)	Opioids (opiates and synthetics)
Users in millions	177.6	34.4	19.36	17.20	16.40	33.00
% of global population 15-64	3.80%	0.70%	0.40%	0.40%	0.40%	0.70%

There has been an increase in global opioid and cannabis use since 2009, while the use of opiates, cocaine and ATS has either remained stable or decreased. Reports on the types of drugs individuals seek treatment for can provide information on which drugs have the highest impact on health in the various geographic regions. Cannabis treatment is prevalent in Africa, the Americas and Oceania. It should be noted that between 2003 and 2012 that those seeking treatment for cannabis increased in Western and Central Europe (19% to 25%), Eastern and South Eastern Europe (8% to 15%), Latin America and the Caribbean (24% to 40%) and Oceania (30% to 46%).

Opioids dominate treatment requests in Eastern and Southern Europe and Asia. Cocaine is major treatment factor in the Americas, especially in Latin America and the Caribbean. ATS use disorders are responsible for a significant proportion of the treatment demand in Asia and Oceania.

Global estimates are that one in six problem drug users got treatment in the past year. However, there are large regional differences. One in 18 problem drug users receive treatment in Africa (mostly for cannabis use), while one in five problem users in Europe, one in four in Oceania and one in three in North America receive treatment.

Drug-related deaths were estimated to be around 183,000 in 2012. Overdose deaths from opioids (heroin and non-medical use of prescription opioids) are the main drug type implicated in those deaths. Most overdoses occur when opioids are mixed with other sedating substances, like alcohol and benzodiazepines. See the global data in the table below from the 2014 World Drug Report.

North America continues to be a major market for illicit drug use. It has the largest percentage of opioid users, cocaine users and cannabis users. It was second in percentage of ATS users. Cocaine use has been declining since 2006, partly because of a sustained shortage. Yet there has been a slight increase in prevalence recently. Columbia’s recent decision to stop spraying coca crops could stimulate a greater resurgence in cocaine use.

In the United States, opioid-dependent drug users are increasingly turning to heroin because of its greater availability and lowered cost to regular users. The greater availability of heroin in the United States is likely due to higher levels of heroin production in Mexico and Mexican traffickers expanding into “white heroin” markets. Anecdotal evidence is that Mexican drug cartels are switching from growing marijuana to opium poppies due to the lower demands for marijuana in the United States. See “The Economics of Heroin.”

The rapid growth of NPS has led to a key supply control strategy of restricting the availability of the precursor chemicals necessary to manufacture them. Most drugs, whether they plant-based or synthetic, require chemicals to change them into the final product. While chemical are only one of the components required for the illicit manufacture of plant-based drugs like heroin and cocaine, ‘they constitute the essential components of illicitly manufactured synthetic drugs.”

NPS are found throughout the globe. Of the 103 countries that gave information for the World Drug Report, 94 countries reported the emergence of some kind of NPS in their markets. The increase from August 2012 to December 2013 of newly identified NPS was mostly due to new synthetic cannabinoids (50% of newly identified new psychoactive substances) followed by new phenethylamines (17%), other substances (14%) and new synthetic cathinones (8%). See the following chart from the 2014 World Drug Report.

Reviewing this report on worldwide drug use reminds me that getting high is an everywhere problem. This year the transition from pharmaceutical painkillers to heroin and the higher cultivation levels of opium poppies suggests a pending increase in heroin addicts and overdose deaths. The rapid explosion of new psychoactive substances onto the drug scene in the past few years feels like a “back to the future” move to the days of patent medicines, when heroin was a cough suppressant and cocaine was a toothache cure. Teething medications contained morphine. Coca-Cola (with cocaine) was a temperance drink and tonic, “a cure for all nervous affections.”

Cannabis is becoming more potent and toxic just as legalization movements gain steam and increase its use and availability. Coca eradication efforts that seemed to have had an effect on the cocaine market are to be suspended—perhaps leading to a resurgence in cocaine use. Getting high is an everywhere problem and it seems like it’s not going away anytime soon.

07/6/15

The Double-Edged Sword of Narco-Terrorism

When I began my first counseling job in the 1980s working at an out patient drug and alcohol center, I didn’t realize I would eventually be on the front line in the war against terrorism. I’ve never been in the military or the CIA. I’ve consistently worked in some capacity with people struggling with drug and alcohol-related problems. But the drug trade and terrorism have merged in a way that is truly disturbing. In effect, the drug trade has become both a weapon and a funding source for terrorists.

The term “narco-terrorism” has a surprisingly long history. It was coined back in 1983 by Peru’s then president Belaunde Terry to describe attacks by cocaine traffickers aligned with the Maoist rebel group the Shining Path against Peruvian police. These days it has a much broader application. Hamas, the Taliban, and even ISIS/ISIL have been implicated in either direct activity with the drug trade or in working with drug cartels by using their distribution routes to move people and weapons.

Alex Perry, writing for Newsweek, described several incidents in West Africa that involved cocaine being smuggled into Europe. In November of 2009 a Boeing 727 landed in eastern Mali with 10 tons of cocaine. After the cocaine was unloaded, the plane was torched. There’s a photo of the burned plane in his article. He described an apparent cocaine smuggling operation that has a connection with the Guinea-Bissau military. A colonel in the Malian secret service was quoted as saying there were convoys every Friday. Half the vehicles carried drugs and half provided security. “Assuming a light load of half a ton per truck, and a minimal schedule of one convoy a month, that’s still 48 tons of cocaine a year – worth around $1.8 billion in Europe.”

Perry commented that the story of cocaine helps to explain how Islamist groups in the Middle East and Africa earn billions of dollars each year. It also described how Europe’s appetite for cocaine disrupted the lives of hundreds of millions of others living in West Africa. He quoted a Western diplomat as saying: “This is about financing terrorism on Europe’s southern border, about drug money from Guinea-Bissau and Mali being used for a bomb in London.”

West Africa was rotten with drugs, its governments corrupt, unstable and unpopular, and much of this shaky edifice was supported by Western aid – a perfect environment for a purifying Islamist revolution. Mali was all the proof anyone needed that Africa’s nationalist leaders and their Western humanitarian backers were false prophets. The democracy held up by foreigners as an example to others was hollow, a narco state with a criminal kingpin in charge. And al-Qaida just happened to have a branch in northern Mali.

FARC, the Revolutionary Armed forces of Columbia, has been involved in the cocaine trade for decades. A paper by John Otis of the Wilson Center described how FARC grew from a rural-based rebel movement to one of the major players in the Columbian cocaine trade. “Massive drug profits help the FARC to buy weapons, uniforms, and supplies and to recruit fresh troops.” U.S. aid to Columbia has contributed to success against FARC, but at least one official with Columbia’s national police estimated FARC still earns about $1 billion from the cocaine trade. Others dispute this figure as too high, yet still acknowledge that FARC is “one of the most powerful drug trafficking syndicates in Columbia, and perhaps the world.”

In 2013, The Mirror reported that FARC sold a large quantity of cocaine to al Qaeda of the Islamic Maghreb (AQMI) in North Africa. They were paid in cash and weapons looted in Libya. This branch of al Qaeda has a long history of involvement with cocaine traffickers, particularly in the protection racket described above that enabled drug runners to safely cross the Algerian Sahara. A recent sting operation led to the arrest of the former head of the navy in Guinea-Bissau. Believing he was talking with members, of FARC, he agreed to supply ground-to-air missiles, AK-47 rifles and grenade launchers for four tons of cocaine with a street value of £168 million ($260.2 million).

The Daily Star said in December of 2014 that the DEA has been recording meetings between AQMI and FARC to agree on prices and negotiate fees since 2010. Certain parts of AQMI have pledged allegiance to ISIS, “forming an Islamic terror network spreading through the Middle East into Europe.” The African trafficking route typically starts in Guinea-Bissau, traveling north through the Sahara desert to Morocco, Algeria and Libya. Cocaine that reaches Morocco goes on to Spain. The Algerian shipments are split between Spain and France. The drug shipments passing through Libya go to the Cammora mafia in Naples and to Malta.

In January of 2015 a reporter for Vice News in Syria was shown some of the personal belongings taken from a ISIS leader who was shot and killed in a firefight. Along with a military-styled Dell laptop was a bag of cocaine. The Kurdish militia commander suggested the dead ISIS commander was distributing small amount to his fighters. If true, this presents the first concrete evidence of drug use among ISIS fighters.

There have been persistent rumors and accusations of drug use in the ranks of Islamic State fighters. Leaders in the group have been said to drug their militants to give them greater courage as they go into battle. This has led to both successful, but also reckless and ineffective suicide attacks by fighters who can easily be shot down. Certain IS militants have been described as “drug-crazed,” and Kurds report having found mysterious pills, capsules, and syringes on living and dead IS fighters. And the slurred speech of the murderer behind the infamous beheadings of kidnapped Westerners, the man dubbed “Jihadi John,” has been explained as him being high on khat.

Paul Shinkman reported for U.S. News in April of 2015 that FARC has developed disposable submarines, so-called “naro-submarines,” that can transport 8 tons of cargo more than 1,000 miles underwater. When the subs reach their destination, they are scuttled and sunk, making it almost impossible to identify and stop them. An admiral in the Columbian navy said: “These kind of artifacts can be used for whoever knows – weapons of mass destruction, illegal trafficking of migration, et cetera.” A report from a U.S. Army research office said the drug smugglers have invested millions of dollars to improve the quality of these submarines, even to the point of hiring Russian naval engineers. Top leaders in the U.S. military believe extremists groups like ISIS have plans to capitalize on these routes.

U.S. Coast Guard Vice Admiral Charles Michel has been warning about the threat posed by these submarines for several years. One of his concerns is whether FARC teams up with extremist group to transport money, drugs, weapons or even people. He said: “You can’t wait for this stuff to come to the United States. . . . Not only is that damaging our system, it gives away the tactical advantage that we have.”

11/3/14

Strange Bedfellows: Terrorists and Drugs

© Hurricanehank | Dreamstime.com - Terrorist In Mask With A Gun Photo — © Hurricanehank | Dreamstime.com – Terrorist In Mask With A Gun Photo

This past May, the DEA raided a Birmingham Alabama warehouse as a part of Project Synergy. Inside, agents found hundreds of thousands of “Scooby Snax” baggies containing spice (synthetic marijuana). Sales of the product were also linked to $40 million in wire transfers to Yemen. Yemen is the home base for Al-Qa‘ida in the Arabian Peninsula (AQAP). While not able to directly link the money to a particular group or organization, DEA spokesperson Rusty Payne said: “It doesn’t take a rocket scientist to figure out that people aren’t sending $40 million to their struggling relatives overseas.”

Derek Maltz, the director of the Special Operations Division of the DEA said: “There’s a significant, long history between drug trafficking and terror organizations.” More than 50 percent of the State Department’s designated foreign terrorist organizations (FTOs) are involved with the drug trade. While the Obama administration has been successful in cutting off state-sponsored funding for terrorist organizations, they have looked for other sources of revenue. The $400 billion annual international drug trade is the most lucrative illicit business in the world and a tempting “investment opportunity” for terrorists.

Maltz went on to say that the synthetic drug market is a “two-for-one deal” for terrorists—they undermine Western countries with the drugs and make millions in the process. We’ve put a bull’s-eye on our back, he said. “When you see a designer synthetic drug industry as lucrative as this in the U.S., it would only be natural that it would be a huge target for those trying to finance their terrorists.”

The world of narcoterrorism has some diversity in its investers. The Taliban in Afghanistan distribute heroin; FARC in Columbia deals in cocaine; and al Shabab in West Africa is alleged to sell khat. While the association of al Shabab and khat may be questionable (here and here), the links between the Taliban and heroin as well as FARC and cocaine are well documented.

While Afghanistan and growing opium have been linked for thousands of years, it has only been in the last three decades that it has become the center for worldwide opium cultivation. Since 2001, opium production in Afghanistan has increased from 70 percent of the overall global opium production to 92 percent. To give you a sense of the size of this, the 2013 World Drug Report indicated that in 2011, Afghanistan produced 5,800 tons of opium, down from 7,400 tons in 2007. The next largest opium producer in 2011 was Myanmar with 610 tons of opium.

The World Bank estimated that the opium GDP of Afghanistan is between $2.6 and $2.7 billion. This amounts to 27 percent of the country’s total GDP, both licit and illicit. And yet, only 3 percent of the natural agricultural land in Afghanistan is used for its production. Poverty is widespread in Afghanistan and many of farmers are compelled by economics and force to grow opium. “Opium is valued at over $4,500 per hectare, as opposed to only $266 for wheat.” Because of this potential profit, many farmers are pressured to cultivate opium by various organizations, warlords and landowners.

The provinces of Helmand and Kandahar, which were regularly in the news during the war in Afghanistan, are also the primary opium producing provinces in the country. As former Afghan president Hamid Karzia said: “The question of drugs . . . is one that will determine Afghanistan’s future. . . . [I]f we fail, we will fail as a state eventually, and we will fall back in the hands of terrorism.”

According to sources in Spanish intelligence, the Islamic State and other jihadist groups are using their connections in the illegal drug market to finance their operations in Iraq and Syria. Jihadists use their knowledge of drug smuggling routes to export arms, contraband and new recruits from Europe to Iraq and Syria. Ironically, the pressure to dry up legal fundraising for terrorist organizations has contributed to their increased trade with illegal arms and drugs.

According to reports from Spain’s recently established government intelligence and counter-terrorism unit CITCO, 20% percent of those detained in Spain under suspicion of working with Islamic State and other jihadist groups have previously served prison sentences for offences such as drug trafficking or document counterfeiting.

FARC rebels control over 60 percent of Columbia’s drug trade, including overseas trafficking. The Revolutionary Armed Forces of Columbia (FARC) earns about $1 billion annually from the production and sale of cocaine in Columbia. According to General Jose Roberto Leon, the head of the Columbian national police force, “We have information found on computers after operations that have captured or killed FARC leaders, and it’s involvement in drug trafficking is evident.” The Columbian anti-narcotics police chief, General Ricardo Restrepo, said that officials fear that if a peace deal with FARC is successfully negotiated, thus cutting into cocaine production, that new gangs producing synthetic drugs will emerge. “It will be our next battle.”

The connection between terrorism and drug trafficking does not currently get much attention in the news media, in part, because the connections are difficult to make. But it does exist and seems to be a growing trend. Spanish intelligence sources have reported that European jihadist groups are using drug smuggling routes to export drug contraband and new recruits from Europe to Iraq and Syria. And most of the cocaine entering Europe is reportedly going through territories controlled by the Islamic State.

The Birmingham bust discussed above is particularly disturbing to me as it connects the making and distribution of the newest addictive danger, new psychoactive substances (NPS), with terrorism. This combination truly is a two-for-one threat. But we can have a two-for-one response to that threat. Both the war on drugs and the war on terrorism can be fought by social policies as well as drug treatment and education that aim for the reduction of drug use. Who would have thought that the slogan in the war on drugs would someday be: Fight Terrorism by Becoming Drug Free.

08/18/14

Sigmund Freud was a Cocaine Evangelist and Addict

So here is the continuing story on Sigmund Freud and cocaine begun in “Raising the Stakes in the War on Cocaine Addiction.” To give a quick recap, Freud began experimenting with cocaine in April of 1884. He used it to treat depression, saying it was a “magic drug.” He hoped that with his help cocaine could “win its place in therapeutics by the side of morphine.”

According to Paul Vitz, Freud’s evangelism of cocaine seems to have been driven by three things:

his intense desire to get married to his fiancée and fear of losing her (a separation anxiety, in Freudian terms);
his drive to become a medical success story in championing the positive effects of a new drug, thus advancing his career and financial prospects (so he could marry); and
to treat his personal struggle with depression (largely induced by his separation anxiety).

When describing his personal experiences in treating his depression with cocaine, Freud said he felt “exhilaration and lasting euphoria, which in no ways differs from the normal euphoria of the healthy person.” He saw an increase in his self-control and capacity for work. He had no unpleasant after effects, as with alcohol and “absolutely no craving” for more cocaine, even after repeated use. “In other words, you are simply normal, and it is soon hard to believe that you are under the influence of any drug.”

He recommended cocaine to family, friends and professional colleagues alike. A friend of Freud’s, Dr. Ernst Fleischl became addicted to morphine while attempting to treat a painful neurological disease. Freud attempted to counteract his morphine addiction with cocaine. At first, cocaine was a helpful substitute for the morphine.

But Fleischl had to increase his cocaine dose as tolerance set in. After one year of cocaine use he was taking a full gram of it daily—TWENTY TIMES the dose Freud personally used. Fleischl was now dually addicted to opiates and cocaine. He soon developed a full-fledged cocaine psychosis, with visions of “white snakes creeping over his skin.”

Freud and other physician friends had little success in weaning Fleischl from his drug use. By June of 1885, Freud thought his friend had about six months to live. Fleischl remained alive for another six pain-filled years. Freud later acknowledged he might have hastened his friend’s death, by “trying to cast out the devil with Beelzebub.”

In July of 1885 a German authority on addiction began publishing a series of articles on cocaine as an addictive drug. A friend of Freud’s, originally favorable towards cocaine, reported that it produced severe mental disturbances. One prominent doctor said Freud had unleashed “the third great scourge of mankind.” The first two were opium and alcohol.

By 1890, the addictive and psychosis producing nature of cocaine was well documented. Freud had moved on in his search for fame and fortune to other interests. And when he co-authored Studies on Hysteria with Joseph Breuer in 1895, psychoanalysis was born. However, Freud continued to use and prescribe cocaine until at least 1896.

Freud 1893 script — image credit: Robert Edwards Auctions.

A handwritten prescription for a “white powder”, signed by Sigmund Freud in 1893, is evidence of his continued cocaine use. In 2004, Robert Edwards Auctions sold this prescription for $2,875.

Freud’s letters to a friend and fellow cocaine user, Wilheim Fleiss, contained several references to his ongoing cocaine use. On January 24, 1895, Freud described to Fleiss how a “cocainization” of his left nostril helped him to an amazing extent. He wrote on April 20, 1895 that he pulled himself out of a miserable (depression?) attack with a cocaine application. On June 12th, 1895, Freud wrote: “I need a lot of cocaine.”

Several scholars have debated whether Freud’s use of cocaine influenced his developing theories. Both Fredrick Crews and E. M. Thornton have argued that Freud’s use of cocaine had a significant influence on his developing theories, especially their emphasis on sex. Thornton claimed that Freud’s psychological theory was the natural outcome of his extensive cocaine usage.

Paul Vitz took a more nuanced approach in Sigmund Freud’s Christian Unconscious, stating that much of Freud’s psychology was evident before he began using cocaine. Freud’s cocaine use may have contributed to sloppy thinking at times. It could have contributed to his preoccupation with sex, or made his depressions darker and more difficult to fight. “But cocaine did not create the primary content and structure of Freud’s mind and thought.”

Yet Thorton presented some rather convincing evidence of Freud’s cocaine “problem” and its potential influence on his theories. Freud himself said that psychoanalysis began with his research into hysteria: “The Studies on Hysteria by Breuer and myself, published in 1895, were the beginnings of psycho-analysis.” Freud began to have heart problems (one of the side effects of cocaine abuse) early in 1894. He suffered from “fainting” spells—four of which were publically witnessed by others. He had an obsession with dreams; some paranoid traits and a tendency towards grandiosity.

In The Interpretation of Dreams, Freud recounted a dream he had in 1895 where he saw a patient with scabs on her turbinal bones, which recalled a worry he had about his own health:

At the time I frequently used cocaine in order to suppress distressing swellings in the nose, and I had heard a few days previously that a lady patient who did likewise had contracted an extensive necrosis of the nasal mucous membrane. In 1885 it was I who had recommended the use of cocaine, and I had been gravely reproached in consequence. A dear friend, who had died before the date of this dream, had hastened his end by the misuse of this remedy.

By 1895 Freud had probably been using cocaine (nasally) for over two years. Physically, the effects of this heavy usage would have been essentially identical to the catalogue of symptoms noted by Fleiss as those for “nasal reflex neurosis” (headache, vertigo, dizziness, acceleration and irregularity of the heart, respiratory difficulties, etc.). So the physical problem that Freud treated with cocaine (nasal reflex neurosis) was essentially caused by his use of cocaine.

His paranoia was evident in the public breakups he had with formerly close associates like Breuer—with whom he wrote Studies in Hysteria (1894), Fliess (1900), and Jung (1913). Freud’s interpretation of Jung’s dream in 1907, just after they met face-to-face for the first time, was that Jung wished to dethrone him and take his place in the psychoanalytic movement.

05/26/14

Raising the Stakes in the War on Cocaine Addiction

image courtesy of iStock

A 28 year old Viennese neurologist named Sigmund Freud read about the benefits of cocaine on Bavarian soldiers. He decided to use it to treat his own problems with depression and chronic fatigue and acquired some from Merck. On April 30th 1884, Freud used cocaine for the first time. He thought it was “a magic drug.”

Cocaine turned his bad mood into cheerfulness; it even helped his indigestion. He wrote to Martha, his fiancée: “In short, it is only now that I feel I am a doctor, since I have helped one patient and hope to help more.” Freud encouraged Martha to try cocaine, “to make her strong and give her cheeks a red color.” He warned her that when he came for a visit, she should expect “a big wild man who has cocaine in his body.”

He gave cocaine to his sisters and also to medical colleagues—both for themselves and for their patients. By July of 1884 he had written and published his first essay praising the therapeutic uses for cocaine. His hope was that he would become a pioneer in the medical uses of cocaine. But there would not be a happy ending to the story of Freud and cocaine.

These days the ongoing saga of medicine and cocaine is the quest to find a vaccine to cure those who become addicted to it.

I’ve been following the attempts to develop a vaccine for cocaine and other illicit drugs since 2009, when the National Institute of Health (NIH) reported on the work of Thomas Kosten with TA-CD. Nora Volkow, the Director of the National Institute on Drug Abuse (NIDA), said: “The results of this study represent a promising step toward an effective medical treatment for cocaine addiction.”

But some of the participants in Phase 1 of the clinical trials reported using TEN TIMES as much cocaine when trying to override the blocking action of the cocaine vaccine. The Washington Post, reported on the Kosten’s research in January of 2010, saying: “Some of the addicts reported to researchers that they had gone broke buying cocaine from multiple dealers, hoping to find a variety that would get them high.”

A 2011 article in the New York Times highlighted the work of Kim Janda who was working on a cocaine vaccine. His laboratory, the Scripps Research Institute, has also worked on vaccines for nicotine and heroin. In June of 2011 Janda published positive results with what he called an “anti-heroin vaccine.”

New York Magazine reported in September of 2013 that Ronald Crystal, the head of genetic medicine at Weill Cornell, had success with the third version of Janda’s original cocaine vaccine. He hopes to begin human trials by the middle of 2014. A side bar indicated that vaccines were in development for alcohol, nicotine, marijuana, heroin, methamphetamine and rohypnol (the date rape drug).

But as Clint Rainy commented in his New York Magazine article, the problem with addiction is it’s not just a physical problem, it’s also psychological. “Even if you can cancel the effects of drugs, can you make us not want to take them?” Crystal thinks that shouldn’t be a problem for his compound, as it was with TA-CD, because they tweaked their compound (dAd5GNE) to have a “more robust” immune response. Crystal’s response seems to miss an important limitation to a purely physiological attempt to cure addictive “disease.” The vaccine can only inhibit the physiological response to the drug; not the psychological one.

While Kosten’s work with TA-CD has begun clinical trials with humans, the work of Janda with heroin and Crystal with cocaine has yet to be tried on humans. But it’s coming soon. One person who responded to the New York Magazine article about Crystal’s cocaine vaccine said: “This would be a dream come true for me and save my life.” He believed that with the vaccine, he wouldn’t get high. After a few months, he imagined he wouldn’t be thinking about it anymore, but would “just keep getting vaccinated to be safe.”

But it seems that developing a cocaine vaccine as an attempt to end cocaine addiction merely raises the stakes for some addicted individuals by requiring larger amounts of the drug to overcome the vaccine. A vaccine doesn’t address the psychic desire for the drug. If a vaccine is successfully developed for heroin and other opioids, their current potential for deadly use could also increase tenfold.

Faith Seeking Understanding

Charles Sigler, D.Phil.

Tag: Cocaine